Efficacy of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery: a Meta-analysis

Objective To explore the effect of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. Methods Databases including PubMed, EMBASE and Cochrane database were systematically queried to identify randomized controlled trial (RCT) research regarding levosimendan treatment for patients with left ventricular dysfunction undergoing cardiac surgery published from inception to July 2017. Meta-analysis was performed using RevMan 5.3. Relevant outcomes included early mortality, acute kidney injury, need for renal replacement therapy, hypotension and arrhythmia. Results Nine literatures with a total of 1 464 participants were included, with 736 patients in levosimendan group and 728 patients in control group respectively. Compared with control drugs, levosimendan reduced early mortality [odds ratio (OR)=0.5, 95% confidence interval (CI): 0.31-0.81, P=0.004], the incidence of acute kidney injury (OR=0.5, 95%CI: 0.32-0.78, P=0.003) and renal replacement therapy (OR=0.54, 95%CI: 0.32-0.90, P=0.03) in patients undergoing cardiac surgery, but did not affect the incidence of hypotension and arrhythmias (OR=1.29, 95%CI: 0.83-1.99, P=0.26. OR=0.65, 95%CI: 0.32-1.35, P=0.25). Conclusions Perioperative administration of levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery may improve patient′s prognosis and reduce complications. The scope of this study is small, so more high quality RCT research are needed to provide more conclusive evidence regarding the benefit of this drug. Key words: Levosimendan; Cardiac insufficiency; Cardiac surgery; Mortality; Acute kidney injury