Abstract
BackgroundPatients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary.MethodsIn a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed.ResultsPreconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1–4) vs 4(3–6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective.ConclusionsPreconditioning with levosimendan, is a cost-effective strategy preventing postoperative low cardiac output in patients with moderate-severe left ventricular systolic dysfunction undergoing elective coronary artery bypass graft surgery.
Highlights
Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output
The double purpose of this study was to asses the effectiveness of preconditioning with levosimendan in order to decrease postoperative low cardiac output (LCO) in patients with impaired left ventricle ejection fraction (LVEF) lower than 40% [3], who will undergo elective isolated Coronary Artery Bypass Grafting (CABG) surgery compared to optimal standard care without levosimendan and to carry out an economic evaluation comparing both strategies, following ISPOR CHEERS methodology
The aim of this study is to demonstrate that the strategy of preconditioning with levosimendan in patients with moderate-severe systolic dysfunction is effective, reducing the appearance of postoperative low cardiac output and being cost-effective, fundamentally reducing immediate postoperative stays in the Intensive Care Unit (ICU).For this reason, since this study is not a randomized study, we considered it necessary to exclude from the study patients who presented predictors of short term worse outcomes and prolonged postoperative ICU Length of Stay (LOS)
Summary
Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Revascularization surgery plays an important role in patients with left ventricular dysfunction and major vessel involvement [1] The benefit of such revascularization on survival or hospitalization for cardiovascular cause by these patients is affected by the increased risk of mortality in the first 30 days postintervention [2]. The definitions of postoperative low cardiac output (LCO) are variable among the studies cited, only LEVO-CTS [4] study was found beneficial against the reduction of postoperative LCO Economic evaluations of this drug are largely focused in the setting of heart failure [6, 7], with little evidence in the field of cardiac surgery. The double purpose of this study was to asses the effectiveness of preconditioning with levosimendan in order to decrease postoperative LCO in patients with impaired left ventricle ejection fraction (LVEF) lower than 40% [3], who will undergo elective isolated CABG surgery compared to optimal standard care without levosimendan and to carry out an economic evaluation comparing both strategies, following ISPOR CHEERS methodology
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
