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Levosimendan and Low Cardiac Output Following Cardiac Surgery: Analysis of Trial Data

Published:March 13, 2023DOI:
      Low cardiac output syndrome (LCOS) following cardiac surgery is characterized by myocardial dysfunction requiring inotropic and mechanical circulatory support and is associated with high morbidity and mortality. Levosimendan, an inodilator that facilitates calcium sensitization of troponin C, has been identified as potential prophylactic cardioprotective treatment for LCOS in patients undergoing cardiac surgery.1 Recent randomized control trials, LEVO-CTS, LICORN and CHEETAH, have not demonstrated prophylactic levosimendan mortality benefit however there may be decreased incidence of LCOS with its use.2-4 It's also possible there remains a therapeutic window of levosimendan in mitigating LCOS that should be investigated. These trials suggest that LCOS mortality may be driven by prolonged cardiopulmonary bypass (CPB) and aortic cross clamp time as well as coronary artery bypass graft surgery with the addition of valvular intervention. Minimizing surgical risk as well as identifying risk factors for LCOS are imperative for mortality reduction in cardiac surgery.



      CPB (cardiopulmonary bypass), EF (ejection fraction), LCOS (low cardiac output syndrome)
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