title: Early levosimendan administration is associated with decreased mortality after cardiac surgery.
abstract: OBJECTIVE
  The aim of this study was to assess the effects on postoperative outcome of levosimendan with respect to timing of its administration in cardiac surgery patients.
  
  
  METHODS
  Levosimendan administration was triggered by a severely reduced left ventricular systolic function (left ventricular ejection fraction, <35%) and/or signs of a low cardiac output syndrome. A total of 159 patients were retrospectively assigned depending on an early (perioperatively up to the first hour after intensive care unit [ICU] admission) vs late (later than the first hour after ICU admission) start of treatment.
  
  
  RESULTS
  Patients receiving levosimendan after the first hour of ICU admission (n = 89) had a significantly increased inhospital (P = .004) and 1-year (P = .027) mortality. Duration of mechanical ventilation (P = .002), incidence of renal dysfunction (P = .002), and need of renal replacement therapy (P = .032) were significantly increased in the late start group. A late start of levosimendan treatment was associated with an odds ratio of 2.258 (95% confidence interval, 1.139-4.550; P = .021) for inhospital mortality and an adjusted hazard ratio of 1.827 (95% confidence interval, 1.155-2.890; P = .010) for 1-year survival.
  
  
  CONCLUSIONS
  Findings of this retrospective analysis favor an "early," that is, intraoperatively up to the first hour after ICU admission, start of perioperative levosimendan treatment to maximize its ability to reduce mortality and morbidity.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: sascha.treskatsch@charite.de.
authors.forename: Sascha
authors.initials: S
authors.lastname: Treskatsch
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: felix.balzer@charite.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Balzer
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: torsten.geyer@charite.de.
authors.forename: Torsten
authors.initials: T
authors.lastname: Geyer
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: claudia.spies@charite.de.
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: marc.kastrup@charite.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Kastrup
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: herko.grubitzsch@charite.de.
authors.forename: Herko
authors.initials: H
authors.lastname: Grubitzsch
authors.affiliation: Sostana GmbH, Berlin, Germany. Electronic address: wernecke@sostana.de.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital of Basel, Basel, Switzerland. Electronic address: joachim.erb@usb.ch.
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Erb
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Helios Klinikum Hildesheim GmbH, Hildesheim, Germany. Electronic address: jan-peter.braun@helios-kliniken.de.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Braun
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: michael.sander@charite.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000188:drug therapy*; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D016016:Proportional Hazards Models; D011724:Pyridazines / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000453:epidemiology / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D000077464:Simendan; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Cardiac surgery; Levosimendan; Low cardiac output syndrome; Mortality; Reduced left ventricular ejection fraction; Timing