• Alberto Zangrillo, Vladimir V Lomivorotov, Antonio Pisano, Maria Grazia Calabrò, Alessandro Belletti, Luca Brazzi, Evgeny V Grigoryev, Fabio Guarracino, Fabrizio Monaco, Eugenio Garofalo, Martina Crivellari, Valery V Likhvantsev, Evgeny V Fominskiy, Gianluca Paternoster, Andrey Yavorovskiy, Vadim V Pasyuga, Alessandro Oriani, Rosalba Lembo, Alessandro Bianchi, A Mara Scandroglio, Marat N Abubakirov, Nora Di Tomasso, Giovanni Landoni, and CHEETAH Study Group.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
• J Crit Care. 2020 Aug 1; 58: 89-95.

PurposePerioperative myocardial dysfunction occurs frequently in cardiac surgery, and is a risk factor for morbidity and mortality. Levosimendan has been suggested to reduce mortality of patients with perioperative myocardial dysfunction. However, long-term outcome data on its efficacy in cardiac surgery are lacking.Materials And MethodsCardiac surgery patients with perioperative myocardial dysfunction were randomized to levosimendan or placebo, in addition to standard inotropic care. One-year mortality data were collected.ResultsWe randomized 506 patients (248 to levosimendan 258 to placebo). At 1-year follow-up, 41 patients (16.5%) died in the levosimendan group, while 47 (18.3%) died in the placebo group (absolute risk difference -1.8; 95% CI -8.4 to 4.9; P = .60). Female sex, history of chronic obstructive pulmonary disease, previous myocardial infarction, serum creatinine, hematocrit, mean arterial pressure, and duration of cardiopulmonary bypass were independently associated with 1-year mortality.ConclusionsLevosimendan administration does not improve 1-year survival in cardiac surgery patients with perioperative myocardial dysfunction. One-year mortality in these patients is 17%. Six predictive factors for long-term mortality were identified.Study Registration NumberNCT00994825 (ClinicalTrials.gov).Copyright © 2020 Elsevier Inc. All rights reserved.

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