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Levosimendan in patients with reduced left ventricular function undergoing isolated coronary or valve surgery
Sean van Diepen1, Rajendra H Mehta2, Jeffrey D Leimberger2
1Division of Cardiology, Departments of Critical Care and Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
The Journal of Thoracic and Cardiovascular Surgery
|July 31, 2019
Summary
Levosimendan reduced 90-day mortality and low cardiac output syndrome (LCOS) in patients undergoing isolated coronary artery bypass grafting (CABG). However, no benefits were observed in valve or combined surgeries, indicating procedure-specific effects for levosimendan.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Levosimendan has shown benefits in specific cardiac surgery populations.
- The LEVO-CTS trial found no overall difference in outcomes with levosimendan versus placebo in a broad cardiac surgery group.
- Previous studies suggested levosimendan's efficacy in isolated coronary artery bypass grafting (CABG).
Purpose of the Study:
- To analyze treatment outcomes and costs of levosimendan versus placebo across different cardiac surgical procedures.
- To investigate whether levosimendan's benefits are specific to certain surgical types, particularly isolated CABG.
- To evaluate the impact of levosimendan on mortality, renal function, myocardial infarction, circulatory support, and costs in subgroups.
Main Methods:
- A prespecified subgroup analysis of the LEVO-CTS trial was conducted.
- Patients were categorized into isolated CABG, isolated valve, or combined CABG/valve surgery groups.
- Outcomes included composite endpoints (mortality, renal replacement, MI, circulatory support), 90-day mortality, low cardiac output syndrome (LCOS), and 30-day costs.
Main Results:
- Levosimendan demonstrated a significant reduction in 90-day mortality (2.1% vs 7.9%) and LCOS (12.0% vs 22.1%) in the isolated CABG group.
- No significant differences in composite outcomes or 90-day mortality were observed for levosimendan in isolated valve or combined procedures.
- Thirty-day medical costs, excluding study drug, showed no significant difference between levosimendan and placebo groups across all procedures.
Conclusions:
- Levosimendan is associated with improved outcomes, specifically lower 90-day mortality and LCOS, in patients undergoing isolated CABG.
- The drug did not show significant benefits in patients undergoing isolated valve or combined CABG/valve surgery.
- These findings highlight the procedure-specific efficacy of levosimendan in cardiac surgery patients.
Keywords:
Levosimindancardiac surgerycoronary artery bypass graftingcostlow cardiac output syndromemortalityvalve surgeryMore Related Videos
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