title: Levosimendan Reduces Mortality in Adults with Left Ventricular Dysfunction Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Levosimendan is implemented in patients with low cardiac output after cardiac surgery. However, the strength of evidence is limited by randomized controlled trials enrolling a small number of patients. Hence we have conducted a systematic review to determine the role of levosimendan in adult cardiac surgery.
  
  
  METHODS
  PUBMED, WoS, Cochrane database, and SCOPUS were systematically queried to identify original English language peer-reviewed literature (inception-October 2014) comparing clinical results of adult cardiac surgery between levosimendan and control. Pooled odds ratio (OR) was calculated using the Peto method; p < 0.05 is significant; results are presented within 95% confidence intervals. Continuous data was compared using standardized mean difference/mean difference.
  
  
  RESULTS
  Fourteen studies were included in the analysis. Levosimendan reduced early mortality in patients with reduced ejection fraction (5.5% vs. 9.1%) (OR 0.48 [0.23-0.76]; p = 0.004). This result was confirmed using sensitivity analysis. Postoperative acute renal failure was lower with levosimendan therapy (7.4% vs. 11.5%). Intensive care unit stay was shorter in the levosimendan cohort comparable in both groups (standardized mean difference -0.31 [-0.53, -0.09]; p = 0.006; I(2)  = 33.6%). Levosimendan-treated patients stayed 1.01 (1.61-0.42) days shorter when compared to control (p = 0.001).
  
  
  CONCLUSIONS
  Our meta-analysis demonstrates that Levosimendan improves clinical outcomes in patients with left ventricular dysfunction undergoing cardiac surgery. Results of the ongoing multicenter randomized controlled trial are awaited to provide more conclusive evidence regarding the benefit of this drug.
authors.affiliation: Asan Medical Center, Ulsan School of Medicine, Seoul, South Korea.
authors.forename: Ju Yong
authors.initials: JY
authors.lastname: Lim
authors.affiliation: Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Abeer
authors.initials: A
authors.lastname: Rababa'h
authors.affiliation: Department of Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Samsung Hospital, Sungkyunkwan School of Medicine, Seoul, South Korea.
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Cho
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Dustin
authors.initials: D
authors.lastname: Hang
authors.affiliation: Health Sciences Library, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: McGraw
authors.affiliation: Department of Anesthesia and Peri-operative Medicine, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Edwin G
authors.initials: EG
authors.lastname: Avery
authors.affiliation: Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Markowitz
authors.affiliation: Division of Cardiovascular Surgery, Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D058186:Acute Kidney Injury / Q000517:prevention & control; D000328:Adult; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016206:Databases, Bibliographic; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000401:mortality* / Q000517:prevention & control; D011724:Pyridazines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000077464:Simendan; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000401:mortality* / Q000517:prevention & control
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan