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Landoni G, Mizzi A, Biondi-Zoccai G, et al.
J Cardiothorac Vasc Anesth 2009 Aug 21 [Epub ahead of print].
The authors conducted a systematic review and meta-analysis of data pooled from existing trials to determine the impact of levosimendan on mortality in patients undergoing cardiac surgery. Inclusion criteria for relevant studies were: random allocation to treatment, comparison of levosimendan versus control, studies performed on cardiac surgery patients with no restriction in dose and time of administration, and information on the primary outcome (mortality).
The primary endpoint was postoperative mortality. Among the secondary end-points were in-hospital myocardial infarction, acute renal failure, rate of atrial fibrillation and troponin release. In total, 10 studies comprising 440 randomised patients (235 patients were randomised to levosimendan and 205 patients were randomised to control) were included in the analysis. Eight studies used levosimendan in cardiac surgery with cardiopulmonary bypass and two studies used levosimendan during off-pump coronary artery bypass grafting. In four studies the controlgroup received placebo, in three studies dobutamine, and in three studies the controlgroup received milrinone.
Levosimendan was associated with significant reduction in postoperative mortality (11/235 [4.7%]) compared with 26/205 [12.7%] in the controlgroup. Odds ratio 0.35, 95% CI: 0.18-0.71, p=0.003. Further, the incidence of atrial fibrillation was reduced, and acute myocardial infarction and renal failure were more seldom seen with levosimendan compared with control.
This meta-analysis showed that perioperative use of levosimendan is associated with a reduction in postoperative mortality. However, randomised controlled studies are needed to confirm the clinical advantages of levosimendan in cardiac surgery.
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