Reducing Mortality in Cardiac Surgery With Levosimendan: A Meta-analysis of Randomized Controlled Trials
published online 24 August 2009.
Objectives
The authors performed a meta-analysis to evaluate whether levosimendan is associated with improved survival in patients undergoing cardiac surgery.
Design
A meta-analysis.
Setting
Hospitals.
Participants
A total of 440 patients from 10 randomized controlled studies were included in the analysis.
Interventions
None.
Measurments and Main Results
Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment, comparison of levosimendan versus control, and cardiac surgery patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no mortality data. The primary endpoint was postoperative mortality. Levosimendan was associated with a significant reduction in postoperative mortality (11/235 [4.7%] in the levosimendan group v 26/205 [12.7%] in the control arm, odds ratio = 0.35 [0.18-0.71], p for effect = 0.003, p for heterogeneity = 0.22, I2 = 27.4% with 440 patients included), cardiac troponin release, and atrial fibrillation. No difference was found in terms of myocardial infarction, acute renal failure, time on mechanical ventilation, intensive care unit, and hospital stay.
Conclusions
Levosimendan has cardioprotective effects that could result in a reduced postoperative mortality. A large randomized controlled study is warranted in this setting.
⁎Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milan, Italy
†Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy
Address reprint requests to Giovanni Landoni, MD, Department of Cardiothoracic Anesthesia and Intensive Care, Istituto Scientifico San Raffaele, Via Olgettina 60, Milano 20132, Italy
This study is part of a senior training project of the Meta-analysis, and Evidence-based medicine Training in Cardiology (METCARDIO) Center, Milan, Italy (http://www.metcardio.org).
ABSTRACT