Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 3;10(8):332.
doi: 10.3390/jcdd10080332.

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

Vasileios Leivaditis  1 , Konstantinos Grapatsas  2 , Anastasia Papaporfyriou  3 , Michail Galanis  4 , Efstratios Koletsis  5 , Nikolaos Charokopos  5 , Erich Haussmann  1 , Vladislav Kaplunov  1 , Athanasios Papatriantafyllou  6 , Manfred Dahm  1
Affiliations

The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery

Vasileios Leivaditis et al. J Cardiovasc Dev Dis. .

Abstract

Background: Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients.

Methods: A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment.

Results: The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions.

Conclusions: This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions.

Keywords: angina pectoris; cardiac surgery; heart failure; levosimendan; myocardial injury.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Overall survival from the date of operation within 30 days after surgery.
Figure 2
Figure 2
Overall survival from the date of operation within 1 year after surgery.
Figure 3
Figure 3
Overall survival from the date of operation within 3 years after surgery.
Figure 4
Figure 4
Boxplot of ejection fraction difference (ΔEF) by cohort. The dots represent the outliers, which are the points that stay out of the interval.
Figure 5
Figure 5
Boxplot of number of readmissions to hospital by cohort. The dots represent the outliers, which are the points that stay out of the interval.
Figure 6
Figure 6
Distribution of troponin I levels in the two cohorts.
Figure 7
Figure 7
Distribution of CK levels in the two cohorts.
Figure 8
Figure 8
Distribution of CK-MB levels in the two cohorts.
See this image and copyright information in PMC

References

    1. Landoni G., Biondi-Zoccai G., Greco M., Greco T., Bignami E., Morelli A., Guarracino F., Zangrillo A. Effects of levosimendan on mortality and hospitalization. A meta-analysis of randomized controlled studies*. Crit. Care Med. 2012;40:634–646. doi: 10.1097/CCM.0b013e318232962a. - DOI - PubMed
    1. Maharaj R., Metaxa V. Levosimendan and mortality after coronary revascularisation: A meta-analysis of randomised controlled trials. Crit. Care. 2011;15:R140. doi: 10.1186/cc10263. - DOI - PMC - PubMed
    1. Levin R., Degrange M., Del Mazo C., Tanus E., Porcile R. Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass. Exp. Clin. Cardiol. 2012;17:125–130. - PMC - PubMed
    1. Chen Q.-H., Zheng R.-Q., Lin H., Shao J., Yu J.-Q., Wang H.-L. Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials. Crit. Care. 2017;21:253. doi: 10.1186/s13054-017-1848-1. - DOI - PMC - PubMed
    1. Belletti A., Castro M., Silvetti S., Greco T., Biondi-Zoccai G., Pasin L., Zangrillo A., Landoni G. The Effect of inotropes and vasopressors on mortality: A meta-analysis of randomized clinical trials. Br. J. Anaesth. 2015;115:656–675. doi: 10.1093/bja/aev284. - DOI - PubMed