Reducing mortality in cardiac surgery with levosimendan: a meta-analysis of randomized controlled trials.
OBJECTIVE
The authors performed a meta-analysis to evaluate whether levosimendan is associated with improved survival in patients undergoing cardiac surgery.


METHODS
A meta-analysis.


METHODS
Hospitals.


METHODS
A total of 440 patients from 10 randomized controlled studies were included in the analysis.


METHODS
None. MEASURMENTS AND MAIN RESULTS: Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment, comparison of levosimendan versus control, and cardiac surgery patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no mortality data. The primary endpoint was postoperative mortality. Levosimendan was associated with a significant reduction in postoperative mortality (11/235 [4.7%] in the levosimendan group v 26/205 [12.7%] in the control arm, odds ratio = 0.35 [0.18-0.71], p for effect = 0.003, p for heterogeneity = 0.22, I(2) = 27.4% with 440 patients included), cardiac troponin release, and atrial fibrillation. No difference was found in terms of myocardial infarction, acute renal failure, time on mechanical ventilation, intensive care unit, and hospital stay.


CONCLUSIONS
Levosimendan has cardioprotective effects that could result in a reduced postoperative mortality. A large randomized controlled study is warranted in this setting.
Landoni
Giovanni
G
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Istituto Scientifico San Raffaele, Via Olgettina 60, Milano 20132, Italy. landoni.giovanni@hsr.it
Mizzi
Anna
A
Biondi-Zoccai
Giuseppe
G
Bruno
Giovanna
G
Bignami
Elena
E
Corno
Laura
L
Zambon
Massimo
M
Gerli
Chiara
C
Zangrillo
Alberto
A
D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality*; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000401:mortality*; D011724:Pyridazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077464:Simendan; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan