Effects of levosimendan on mortality in patients undergoing cardiac surgery: A systematic review and meta-analysis

PurposeWe sought to determine the impact of levosimendan on mortality following cardiac surgery based on large-scale randomized controlled trials (RCTs). MethodsWe searched PubMed, Web of Science, Cochrane databases, and for RCTs published up to December 2017, on levosimendan for patients undergoing cardiac surgery. ResultsA total of 25 RCTs enrolling 2960 patients met the inclusion criteria; data from 15 placebo-controlled randomized trials were included for meta-analysis. Pooled analysis showed that the all-cause mortality rate was 6.4% (71 of 1106) in the levosimendan group and 8.4% (93 of 1108) in the placebo group (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55-1.04; P=0.09). There were no significant differences between the two groups in the rates of myocardial infarction (OR: 0.91; 95% CI, 0.68-1.21; P=0.52), serious adverse events (OR: 0.84; 95% CI, 0.66-1.07; P=0.17), hypotension (OR: 1.69; 95% CI, 0.94-3.03; P=0.08), and low cardiac output syndrome (OR: 0.47; 95% CI, 0.22-1.02; P=0.05). ConclusionLevosimendan did not result in a reduction in mortality in adult cardiac surgery patients. Well designed, adequately powered, multicenter trials are necessary to determine the role of levosimendan in adult cardiac surgery.