Early levosimendan administration is associated with decreased mortality after cardiac surgery

Abstract Purpose The aim of this study was to assess the effects on postoperative outcome of levosimendan with respect to timing of its administration in cardiac surgery patients. Materials and methods Levosimendan administration was triggered by a severely reduced left ventricular systolic function (left ventricular ejection fraction, Results Patients receiving levosimendan after the first hour of ICU admission (n = 89) had a significantly increased inhospital ( P = .004) and 1-year ( P = .027) mortality. Duration of mechanical ventilation ( P = .002), incidence of renal dysfunction ( P = .002), and need of renal replacement therapy ( P = .032) were significantly increased in the late start group. A late start of levosimendan treatment was associated with an odds ratio of 2.258 (95% confidence interval, 1.139-4.550; P = .021) for inhospital mortality and an adjusted hazard ratio of 1.827 (95% confidence interval, 1.155-2.890; P = .010) for 1-year survival. Conclusions Findings of this retrospective analysis favor an “early,” that is, intraoperatively up to the first hour after ICU admission, start of perioperative levosimendan treatment to maximize its ability to reduce mortality and morbidity.