title: Impact of prophylactic administration of Levosimendan on short-term and long-term outcome in high-risk patients with severely reduced left-ventricular ejection fraction undergoing cardiac surgery - a retrospective analysis.
abstract: BACKGROUND
  Patients with severely reduced left-ventricular ejection fraction carry a high risk of morbidity and mortality after cardiac surgery. Levosimendan can be used prophylactically in these patients having shown positive effects on short-term outcome. However, effects on long-term outcome and patient subgroups benefiting the most are unknown. We aim to address these topics with real-life data from our clinical practice.
  
  
  METHODS
  Two hundred eigthy eight patients with preoperative LVEF ≤ 35% underwent cardiac surgery with cardiopulmonary bypass between 2009 and 2013. Thereof, 246 were included in the matched analysis. Eigthy two patients received 12.5mg Levosimendan starting at induction of anesthesia. Outcomes of patients undergoing coronary artery bypass grafting surgery (n = 103), isolated valve surgery/ascending aortic surgery (n = 45) and those undergoing combination procedures (n = 98) were analyzed separately. Additionally, multivariate regression analysis was conducted in order to identify predictors of short-term outcome parameters for different subgroups of patients.
  
  
  RESULTS
  Thirty days mortality rates of 16% in the Levosimendan group and 21% in the control group (OR 0.7; 95%-CI 0.36-1.5; p = 0.37) were observed. Levosimendan showed a positive effect on postoperative renal function. A higher rate of new-onset atrial fibrillation (OR 4.0; 95%-CI 2.2-7-2; p < 0.0001) was observed in the Levosimendan group. Follow-up until three years postoperatively showed no differences in long-term survival between the groups.
  
  
  CONCLUSIONS
  Prophylactic administration of Levosimendan did not affect overall short- and long-term outcomes. The value of prophylactic use of Levosimendan remains questionable and more data is needed to confirm subgroups that might benefit most.
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany. Philippe.grieshaber@chiru.med.uni-giessen.de.
authors.forename: Philippe
authors.identifier: http://orcid.org/0000-0003-4139-7983
authors.initials: P
authors.lastname: Grieshaber
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany.
authors.forename: Stella
authors.initials: S
authors.lastname: Lipp
authors.affiliation: Department of Neurology, University Hospital Giessen, Giessen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Arnold
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Görlach
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Giessen, Giessen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wollbrück
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Roth
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Niemann
authors.affiliation: Department of Internal Medicine, German Center for Lung Research, Justus Liebig University, Giessen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Wilhelm
authors.affiliation: Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Böning
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000139:chemically induced; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011724:Pyridazines / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D000077464:Simendan; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Cardiac surgery; High-risk patients; Levosimendan; Low cardiac output syndrome