Levosimendan reduces cardiac troponin release after cardiac surgery: a meta-analysis of randomized controlled studies.
OBJECTIVE
The authors performed a meta-analysis to investigate the effects of levosimendan in cardiac surgery. Inotropic drugs have never shown beneficial effects on outcome in randomized controlled studies, with the possible exception of levosimendan.


METHODS
A meta-analysis.


METHODS
Hospitals.


METHODS
A total of 139 patients from 5 randomized controlled studies were included in the analysis.


METHODS
None.


RESULTS
Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment, and comparison of levosimendan versus control performed on cardiac surgery patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoint was postoperative cardiac troponin release. Levosimendan was associated with a significant reduction in cardiac troponin peak release (weighted mean difference = 2.5 ng/dL [-3.86, -1.14], p = 0.0003) and in time to hospital discharge (weighted mean difference = -1.38 days [-2.78, 0.03], p = 0.05). No other relevant outcome (mortality, myocardial infarction, atrial fibrillation, time on mechanical ventilation, and intensive care unit stay) was improved in those patients receiving levosimendan.


CONCLUSIONS
Levosimendan has cardioprotective effects, resulting in reduced postoperative cardiac troponin release.
Zangrillo
Alberto
A
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy.
Biondi-Zoccai
Giuseppe
G
Mizzi
Anna
A
Bruno
Giovanna
G
Bignami
Elena
E
Gerli
Chiara
C
De Santis
Vincenzo
V
Tritapepe
Luigi
L
Landoni
Giovanni
G
D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D023381:Endpoint Determination; D006321:Heart / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D009206:Myocardium / Q000378:metabolism*; D011184:Postoperative Period; D011724:Pyridazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D018570:Risk Assessment; D000077464:Simendan; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism*
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D014336:Troponin; D000077464:Simendan