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Prophylactic levosimendan in patients with low ejection fraction undergoing coronary artery bypass grafting: A pooled

Thibaut Caruba1, Anaïs Charles-Nelson1, John H Alexander2

  • 1AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France.

Anaesthesia, Critical Care & Pain Medicine
|June 1, 2022
PubMed

Insights

Preoperative levosimendan did not reduce overall mortality in patients with left ventricular dysfunction undergoing heart surgery. However, it significantly decreased 90-day mortality in those receiving isolated coronary artery bypass grafting (CABG).

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pharmacology

Background:

  • Left ventricular ejection fraction (LVEF) ≤ 40% indicates significant cardiac dysfunction.
  • Coronary artery bypass grafting (CABG) is a common procedure for heart disease.
  • Levosimendan is a medication used to improve cardiac function.

Purpose of the Study:

  • To evaluate the effect of preoperative levosimendan on 90-day mortality in patients with LVEF ≤ 40%.
  • To determine if levosimendan's effect differs between isolated CABG and combined CABG with valve replacement surgery.

Main Methods:

  • Pooled analysis of two multicenter randomized controlled trials (RCTs).
  • Meta-analysis of all relevant RCTs on the topic.
  • Inclusion of 1084 patients (809 isolated CABG, 275 combined surgery) in the pooled analysis.
  • Inclusion of 1441 patients across 6 RCTs in the meta-analysis.

Main Results:

  • Overall 90-day mortality was not significantly different between levosimendan and placebo groups (HR: 0.73, 95% CI: 0.41-1.28).
  • A significant interaction was found between surgery type and levosimendan (p=0.004).
  • Mortality decreased in the isolated CABG subgroup (HR: 0.39, 95% CI: 0.19-0.82) but not in the combined surgery subgroup (HR: 1.73, 95% CI: 0.77-3.92).
  • Meta-analysis confirmed this differential effect on mortality.

Conclusions:

  • Preoperative levosimendan did not reduce mortality in a mixed population with LV dysfunction.
  • Isolated CABG patients showed reduced 90-day mortality with levosimendan.
  • No significant mortality benefit was observed in combined surgery patients.
  • Further prospective trials are needed to confirm these findings.
Abstract

Keywords:
Coronary artery bypass surgery (CABG)LevosimendanMortalityValve replacement surgery

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