title: Reducing mortality in cardiac surgery with levosimendan: a meta-analysis of randomized controlled trials.
abstract: 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.
authors.affiliation: 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
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Anna
authors.initials: A
authors.lastname: Mizzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bruno
authors.forename: Elena
authors.initials: E
authors.lastname: Bignami
authors.forename: Laura
authors.initials: L
authors.lastname: Corno
authors.forename: Massimo
authors.initials: M
authors.lastname: Zambon
authors.forename: Chiara
authors.initials: C
authors.lastname: Gerli
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: 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
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan