Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass

Despite the reduction in perioperative mortality observed over the past two decades, the risk of performing cardiac surgery in patients with coronary artery disease (CAD) and severe left ventricular dysfunction (SLVD) remains high, especially with regard to the likelihood of developing postoperative low cardiac output syndrome (LCOS) (1–4). Concern regarding postoperative LCOS, along with an increasing number of patients with SLVD being referred for surgery, has incentivized cardiac surgery teams to propose several strategies to confront the increased risk of LCOS in this group of patients, such as the preoperative use of an intra-aortic balloon pump (IABP) or the use of off-pump coronary revascularization (5–8). The beneficial effects of the calcium sensitizer levosimendan have previously been demonstrated in LCOS patients, and its unique properties make it a potential option for preoperative treatment in this high-risk class of patients (9,10). The aim of the present study was to assess the risks of postoperative LCOS and mortality following the preoperative administration of levosimendan compared with administration of a placebo in patients with SLVD. Secondary outcomes including difficult weaning from cardiopulmonary bypass (CPB) and the requirements for inotropes, vasopressors and IABP were also evaluated.