• Vladimir Boboshko, Vladimir Lomivorotov, Pavel Ruzankin, Sergey Khrushchev, Liudmila Lomivorotova, Fabrizio Monaco, Maria Grazia Calabrò, Marco Comis, Tiziana Bove, Antonio Pisano, and Alessandro Belletti.
• Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia. Electronic address: vaboboshko@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 10.

ObjectiveTo test the hypothesis that levosimendan administration in patients with low cardiac output syndrome after cardiac surgery is associated with improved long-term (5-year follow-up) outcomes.DesignSingle-center subanalysis of the multicenter randomized CHEETAH trial.SettingCardiac surgery department of a tertiary hospital.ParticipantsA total of 134 adult patients requiring hemodynamic support for a cardiac index <2.5 L/min/m2 after cardiac surgery with cardiopulmonary bypass (CPB).InterventionsPatients were randomized (1:1 ratio) to receive levosimendan (continuous infusion with a starting dose of 0.05 μg/kg/min) or placebo, in addition to standard inotropic care.Measurements And Main ResultsThe primary endpoint was long-term mortality (1-5 years) after randomization. Secondary outcomes were hemodynamic parameters, need for inotropic support, acute kidney injury (AKI), need for renal replacement therapy, duration of mechanical ventilation, intensive care unit (ICU) and hospital stay, and 30-day mortality. No significant between-group difference in long-term mortality (5 years) was observed (hazard ratio, 1.59; 95% confidence interval, 0.81 to 3.11; p = 0.17). There were no significant differences in secondary outcomes, except for the difference in the mean pulmonary artery pressure at 4 to 6 hours after randomization, which was lower in the levosimendan group compared to the placebo group (median, 24 [interquartile range (IQR), 21.8-28] mmHg vs 26 [IQR, 22.2-33] mmHg; p = 0.019).ConclusionsAmong patients requiring hemodynamic support after cardiac surgery with CPB, perioperative levosimendan infusion did not affect long-term survival (1-5 years) compared with placebo. Levosimendan also had no effect on major clinical outcomes such as AKI, ICU stay, hospital stay, and 30-day mortality.Copyright © 2024 Elsevier Inc. All rights reserved.

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