Preoperative Levosimendan in Patients With Severe Left Ventricular Dysfunction Undergoing Isolated Coronary Artery Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials

Abstract

ObjectiveTo verify the impact of preoperative levosimendan on patients with severe left ventricular dysfunction (ejection fraction < 35%) undergoing isolated coronary artery bypass grafting. DesignA meta-analysis SettingHospitals ParticipantsWe included 1,225 patients from six randomized controlled trials. InterventionsNone. Measurements & Main ResultsWe performed a meta-analysis of trials that compared preoperative levosimendan with placebo or no therapy, reporting efficacy and safety endpoints.Statistical analyses used mean differences and risk ratios (RR) with a random effects model. We included six studies comprising 1225 patients, of whom 615 (50.2%) received preoperative levosimendan and 610 (49.8%) received placebo/no therapy. Preoperative levosimendan showed a lower risk of all-cause mortality (RR 0.31; 95% CI 0.16-0.60; p <0.01; I2 = 0%), postoperative acute kidney injury (AKI; RR 0.44; 95% CI 0.25-0.77; p<0.01; I2=0%), LCOS (RR 0.45; 95% CI 0.30-0.66; p<0.001; I2=0%), and postoperative atrial fibrillation (AF; RR 0.49; 95% CI 0.25-0.98; p=0.04; I2=85%) compared to control. Moreover, levosimendan significantly reduced the need for postoperative inotropes and increased the cardiac index at 24 hours postoperative. There were no differences between groups for perioperative myocardial infarction, hypotension, or any adverse events. ConclusionPreoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated coronary artery bypass grafting was associated with reduced all-cause mortality, low cardiac output syndrome, acute kidney injury, postoperative atrial fibrillation, and the need for circulatory support without compromising safety.