• Robert W Harrison, Vic Hasselblad, Rajendra H Mehta, Ricardo Levin, Robert A Harrington, and John H Alexander.
• Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC. Electronic address: robert.w.harrison@duke.edu.
• J. Cardiothorac. Vasc. Anesth.. 2013 Dec 1;27(6):1224-32.

ObjectiveLeft ventricular systolic dysfunction is associated with increased morbidity and mortality in patients undergoing cardiac surgery. The authors performed a meta-analysis investigating the effects of levosimendan in cardiac surgery patients with and without preoperative systolic dysfunction.DesignMeta-analysis of randomized controlled trials.SettingHospital.ParticipantsThe 1,155 patients who participated in 14 randomized controlled trials of perioperative levosimendan were included.InterventionsNone.Measurements And Main ResultsPubMed, EMBASE, the Cochrane database of clinical trials, and conference proceedings were searched for clinical trials of perioperative levosimendan in patients undergoing cardiac surgery through May 1, 2012. Studies were grouped by mean ejection fraction (EF). Those with a mean EF <40% were designated as low-EF. Pooled results demonstrated a reduction in mortality with levosimendan (risk difference [RD]-4.2%; 95% CI -7.2%, -1.1%; p = 0.008). Subgroup analysis showed that this benefit was confined to the low-EF studies (RD -7.0%; 95% CI -11.0%, -3.1%; p < 0.001). No benefit was observed in the preserved-EF subgroup (RD +1.1%; 95% CI -3.8%, +5.9%; p = 0.66). Significant reductions also were seen in the need for dialysis (RD -4.9%; 95% CI -8.2%, -1.6%; p = 0.003), myocardial injury (RD -5.0%; 95% CI -8.3%, -1.7%; p = 0.003), and postoperative atrial fibrillation (RD -8.1%; 95% CI -13.3%, -3.0%; p = 0.002).ConclusionsLevosimendan was associated with reduced mortality and other adverse outcomes in patients undergoing cardiac surgery, and these benefits were greatest in patients with reduced EF. These data support the need for adequately powered randomized clinical trials to confirm the benefits of levosimendan in patients with reduced EF undergoing cardiac surgery.Copyright © 2013 Elsevier Inc. All rights reserved.

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