Abstract
BackgroundPatients with severely reduced left-ventricular ejection fraction carry a high risk of morbidity and mortality after cardiac surgery. Levosimendan can be used prophylactically in these patients having shown positive effects on short-term outcome. However, effects on long-term outcome and patient subgroups benefiting the most are unknown. We aim to address these topics with real-life data from our clinical practice.MethodsTwo hundred eigthy eight patients with preoperative LVEF ≤ 35% underwent cardiac surgery with cardiopulmonary bypass between 2009 and 2013. Thereof, 246 were included in the matched analysis. Eigthy two patients received 12.5mg Levosimendan starting at induction of anesthesia. Outcomes of patients undergoing coronary artery bypass grafting surgery (n = 103), isolated valve surgery/ascending aortic surgery (n = 45) and those undergoing combination procedures (n = 98) were analyzed separately. Additionally, multivariate regression analysis was conducted in order to identify predictors of short-term outcome parameters for different subgroups of patients.ResultsThirty days mortality rates of 16% in the Levosimendan group and 21% in the control group (OR 0.7; 95%–CI 0.36–1.5; p = 0.37) were observed. Levosimendan showed a positive effect on postoperative renal function. A higher rate of new-onset atrial fibrillation (OR 4.0; 95%–CI 2.2–7-2; p < 0.0001) was observed in the Levosimendan group. Follow-up until three years postoperatively showed no differences in long-term survival between the groups.ConclusionProphylactic administration of Levosimendan did not affect overall short- and long-term outcomes. The value of prophylactic use of Levosimendan remains questionable and more data is needed to confirm subgroups that might benefit most.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-016-0556-2) contains supplementary material, which is available to authorized users.
Highlights
Patients with severely reduced left-ventricular ejection fraction carry a high risk of morbidity and mortality after cardiac surgery
LS effects have been thoroughly investigated in the treatment for acutely decompensated chronic heart failure, showing positive results when compared to either dobutamine (RUSSLAN study) or placebo (LIDO study) [3, 4]
In order to give an update from the clinical routine and to generate hypotheses for further studies, we investigated, if the effect of prophylactic LS administration on shortterm outcome can be confirmed in patients with preoperative Left-ventricular ejection fraction (LVEF) ≤35% undergoing cardiac surgery outside the controlled setting of prospective trials
Summary
Patients with severely reduced left-ventricular ejection fraction carry a high risk of morbidity and mortality after cardiac surgery. Levosimendan can be used prophylactically in these patients having shown positive effects on short-term outcome. Levosimendan (LS) improves myocardial contractility without increasing myocardial oxygen demand by increasing calcium-sensitivity of the myocardial contractile units through binding to troponin C [1]. It induces systemic vascular and coronary artery dilation through activation of adenosine triphosphate (ATP)dependent potassium channels in the vascular smooth muscle cells [2]. Patients with preoperatively severely reduced ventricular contractility undergoing cardiac surgery with cardiopulmonary bypass (CPB) carry a substantial risk of postoperative low cardiac output syndrome with its consequences (organ malperfusion, shock, multi-organ failure). The advantageous properties of LS make it a promising therapeutic or even prophylactic option for prevention of these complications
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