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Preoperative Levosimendan in Patients With Severe Left Ventricular Dysfunction Undergoing Isolated Coronary Artery Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials

2023; Elsevier BV; Volume: 38; Issue: 3 Linguagem: Inglês

10.1053/j.jvca.2023.11.036

ISSN

1532-8422

Autores

Rafael Ayala, Douglas Mesadri Gewehr, Amanda Godoi, Camilo A. Velásquez, Miguel Godeiro Fernandez, Pedro E.P. Carvalho, Nora Goebel,

Tópico(s)

Cardiac, Anesthesia and Surgical Outcomes

Resumo

Objective To verify the impact of preoperative levosimendan on patients with severe left ventricular dysfunction (ejection fraction <35%) undergoing isolated coronary artery bypass grafting. Design A meta-analysis. Setting Hospitals. Participants The authors included 1,225 patients from 6 randomized controlled trials. Interventions None. Measurements and Main Results The authors performed a meta-analysis of trials that compared preoperative levosimendan with placebo or no therapy, reporting efficacy and safety endpoints. Statistical analyses used mean differences and risk ratios (RR), with a random effects model. Six studies were included, comprising 1,225 patients, of whom 615 (50.2%) received preoperative levosimendan, and 610 (49.8%) received placebo/no therapy. Preoperative levosimendan showed a lower risk of all-cause mortality (RR 0.31; 95% CI 0.16-0.60; p < 0.01; I 2 = 0%), postoperative acute kidney injury (RR 0.44; 95% CI 0.25-0.77; p < 0.01; I 2 = 0%), low-cardiac-output syndrome (RR 0.45; 95% CI 0.30-0.66; p < 0.001; I 2 = 0%), and postoperative atrial fibrillation (RR 0.49; 95% CI 0.25-0.98; p=0.04; I 2 = 85%) compared to control. Moreover, levosimendan significantly reduced the need for postoperative inotropes and increased the cardiac index at 24 hours postoperatively. There were no differences between groups for perioperative myocardial infarction, hypotension, or any adverse events. Conclusion Preoperative levosimendan in patients with severe left ventricular dysfunction undergoing isolated coronary artery bypass grafting was associated with reduced all-cause mortality, low-cardiac-output syndrome, acute kidney injury, postoperative atrial fibrillation, and the need for circulatory support without compromising safety.

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