Effects of levosimendan on mortality in patients undergoing cardiac surgery: A systematic review and meta-analysis

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Cardiac surgery carries significant risks, including mortality and complications.
• Levosimendan is a medication used to improve cardiac contractility.
• Its efficacy and safety in reducing mortality after cardiac surgery require thorough investigation.

Purpose of the Study:

• To evaluate the impact of levosimendan on mortality rates in adult patients undergoing cardiac surgery.
• To synthesize evidence from large-scale randomized controlled trials (RCTs) to determine levosimendan's effect on post-operative outcomes.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Web of Science, Cochrane databases, and ClinicalTrials.gov.
• Included studies were randomized controlled trials (RCTs) published up to December 2017, focusing on levosimendan use in cardiac surgery patients.
• A meta-analysis was performed on data from 15 placebo-controlled RCTs involving 2960 patients.

Main Results:

• Pooled analysis of 15 placebo-controlled RCTs (2960 patients) showed no significant difference in all-cause mortality between levosimendan and placebo groups (6.4% vs. 8.4%, OR 0.76, P=0.09).
• No significant differences were observed in rates of myocardial infarction, serious adverse events, hypotension, or low cardiac output syndrome between the groups.
• While trends suggested potential benefits for low cardiac output syndrome (OR 0.47, P=0.05), overall mortality was not significantly reduced.

Conclusions:

• Levosimendan administration did not lead to a statistically significant reduction in mortality for adult patients undergoing cardiac surgery.
• Current evidence suggests that levosimendan is not associated with reduced mortality in this population.
• Larger, well-designed, multicenter trials are essential to definitively establish the role, if any, of levosimendan in adult cardiac surgery.