Impact of prophylactic administration of Levosimendan on short-term and long-term outcome in high-risk patients with severely reduced left-ventricular ejection fraction undergoing cardiac surgery – a retrospective analysis

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.

Use of Levosimendan in Cardiac Surgery: An Update After the LEVO-CTS, CHEETAH, and LICORN Trials in the Light of Clinical Practice

“… 17 Indications of renal-protective effects in this setting have also been reported in retrospective analyses. 18 , 19 …”

Pre-bypass levosimendan in ventricular dysfunction-effect on right ventricle

“…9 We found AF in 3 (10%) patients and intermittent premature ventricular contractions in 5 (17%) following levosimendan infusion up to 48 h postoperatively. Grieshaber and colleagues 17 also found a higher rate (76%) of new-onset AF within 24 h postoperatively in patients receiving prophylactic levosimendan, compared to 44% in the control group. Similarly, the incidence of AF was greater in the levosimendan group (36.6% vs. 6.6%) in a study by Desai and colleagues, 18 but in the LICORN study, there was no significant difference in the incidence of postoperative AF (50% vs. 40%, levosimendan vs. placebo).…”

Levosimendan: evolution over last two decades

“…Three years follow up showed no differences in long-term survival between the groups. 5 In a prospective, double-blind, randomized pilot study, effectiveness of prophylactic levosimendan in patients with impaired left ventricular function undergoing CABG was evaluated. Thirty-two patients undergoing CABG with low LVEF ≤40% were randomized to receive either a continuous infusion of levosimendan at a dose of 0.1 μg/kg/min for 24 hours without a loading dose or a placebo.…”