Perioperative Use of Levosimendan in Patients with Severe Left Ventricular Dysfunction Undergoing Cardiac Surgery A Systematic Review and Meta-analysis

Mansour, Ahmed; Abd Elhamed, Osama Abbas; Fouad, Ahmed Ahmed; Reda, Ramy Mohamed

doi:10.21608/asmj.2022.159340.1043

	Perioperative Use of Levosimendan in Patients with Severe Left Ventricular Dysfunction Undergoing Cardiac Surgery A Systematic Review and Meta-analysis
Ain Shams Medical Journal
Volume 75, Issue 1, March 2024
Document Type: Original Article
DOI: 10.21608/asmj.2022.159340.1043
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Authors
Ahmed Mansour ¹; Osama Abbas Abd Elhamed²; Ahmed Ahmed Fouad²; Ramy Mohamed Reda²
¹Cardiothoracic surgery Department, Faculty of medicine, Cairo University, Cairo, Egypt
²Cardiothoracic surgery Department, Faculty of medicine, Ain Shams University
Abstract
Background: Levosimendan is a calcium-sensitizing ionodilator. However, the current level of clinical evidence is insufficient to determine the clinical value of levosimendan in patients with severe left ventricular dysfunction subjected to cardiac surgery. The aim of this meta-analysis to provide an update of the current clinical evidence regarding the clinical value of perioperative levosimendan use in adult patients with severe cardiac dysfunction subjected to cardiac surgery. Methods: This meta-analysis was performed according to PRISMA statement. Databases searched included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews. Search keywords were extracted from initially retrieved articles and comprised “levosimendan” and “cardiac surgery” using the Boolean search operator AND. The reported outcomes included early mortality, development of atrial fibrillation, acute kidney injury and/or renal replacement therapy, postoperative myocardial infarction, hypotension and low cardiac output syndrome. Results: The present meta-analysis showed significant association between levosimendan use and significant reduction of perioperative low cardiac output syndrome [OR (95% CI): 0.60 (0.44-0.82), p=0.001], renal injury and/or renal replacement therapy [OR (95% CI): 0.51 (0.30-0.86), p=0.01]. Also, levosimendan use was associated with a marginal trend towards lower mortality [OR (95% CI): 0.64 (0.39-1.03), p=0.07]. Conclusions: Levosimendan use is associated with reduction of perioperative low cardiac output syndrome and renal injury and/or renal replacement therapy.
Keywords
Levosimendan; Cardiac surgery; low cardiac output syndrome


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