Levosimendan for Hemodynamic Support after Cardiac Surgery
Giovanni Landoni, Vladimir V Lomivorotov, Gabriele Alvaro, Rosetta Lobreglio, Antonio Pisano, Fabio Guarracino, Maria G Calabrò, Evgeny V Grigoryev, Valery V Likhvantsev, Marcello F Salgado-Filho, Alessandro Bianchi, Vadim V Pasyuga, Massimo Baiocchi, Federico Pappalardo, Fabrizio Monaco, Vladimir A Boboshko, Marat N Abubakirov, Bruno Amantea, Rosalba Lembo, Luca Brazzi, Luigi Verniero, Pietro Bertini, Anna M Scandroglio, Tiziana Bove, Alessandro Belletti, Maria G Michienzi, Dmitriy L Shukevich, Tatiana S Zabelina, Rinaldo Bellomo, Alberto Zangrillo, CHEETAH Study Group, Guido Frascaroli, Giovanni De Vuono, Eugenio Garofalo, Francesca Gencarelli, Angela Madeo, Patrizia Sannuto, Emanuela Saporito, Angelo Gratarola, Giuseppe Buscaglia, Aba Lizzi, Giovanni Affronti, Martina Crivellari, Nora Di Tomasso, Evgeny V Fominskiy, Samuele Frassoni, Alessandro Oriani, Manuela Angelone, Adele Conte, Stefania Gargiulo, Daniela Giuseppina Giordano, Daniele Amitrano, Rubia Baldassarri, Claudia Cariello, Luca Doroni, Carmelo Vullo, Gianluca Paternoster, Giuseppe Pittella, Vito Marco Ranieri, Mauro Rinaldi, Gabriella Buono, Marco Comis, Giovanni Landoni, Vladimir V Lomivorotov, Gabriele Alvaro, Rosetta Lobreglio, Antonio Pisano, Fabio Guarracino, Maria G Calabrò, Evgeny V Grigoryev, Valery V Likhvantsev, Marcello F Salgado-Filho, Alessandro Bianchi, Vadim V Pasyuga, Massimo Baiocchi, Federico Pappalardo, Fabrizio Monaco, Vladimir A Boboshko, Marat N Abubakirov, Bruno Amantea, Rosalba Lembo, Luca Brazzi, Luigi Verniero, Pietro Bertini, Anna M Scandroglio, Tiziana Bove, Alessandro Belletti, Maria G Michienzi, Dmitriy L Shukevich, Tatiana S Zabelina, Rinaldo Bellomo, Alberto Zangrillo, CHEETAH Study Group, Guido Frascaroli, Giovanni De Vuono, Eugenio Garofalo, Francesca Gencarelli, Angela Madeo, Patrizia Sannuto, Emanuela Saporito, Angelo Gratarola, Giuseppe Buscaglia, Aba Lizzi, Giovanni Affronti, Martina Crivellari, Nora Di Tomasso, Evgeny V Fominskiy, Samuele Frassoni, Alessandro Oriani, Manuela Angelone, Adele Conte, Stefania Gargiulo, Daniela Giuseppina Giordano, Daniele Amitrano, Rubia Baldassarri, Claudia Cariello, Luca Doroni, Carmelo Vullo, Gianluca Paternoster, Giuseppe Pittella, Vito Marco Ranieri, Mauro Rinaldi, Gabriella Buono, Marco Comis
Abstract
Background: Acute left ventricular dysfunction is a major complication of cardiac surgery and is associated with increased mortality. Meta-analyses of small trials suggest that levosimendan may result in a higher rate of survival among patients undergoing cardiac surgery.
Methods: We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving patients in whom perioperative hemodynamic support was indicated after cardiac surgery, according to prespecified criteria. Patients were randomly assigned to receive levosimendan (in a continuous infusion at a dose of 0.025 to 0.2 μg per kilogram of body weight per minute) or placebo, for up to 48 hours or until discharge from the intensive care unit (ICU), in addition to standard care. The primary outcome was 30-day mortality.
Results: The trial was stopped for futility after 506 patients were enrolled. A total of 248 patients were assigned to receive levosimendan and 258 to receive placebo. There was no significant difference in 30-day mortality between the levosimendan group and the placebo group (32 patients [12.9%] and 33 patients [12.8%], respectively; absolute risk difference, 0.1 percentage points; 95% confidence interval [CI], -5.7 to 5.9; P=0.97). There were no significant differences between the levosimendan group and the placebo group in the durations of mechanical ventilation (median, 19 hours and 21 hours, respectively; median difference, -2 hours; 95% CI, -5 to 1; P=0.48), ICU stay (median, 72 hours and 84 hours, respectively; median difference, -12 hours; 95% CI, -21 to 2; P=0.09), and hospital stay (median, 14 days and 14 days, respectively; median difference, 0 days; 95% CI, -1 to 2; P=0.39). There was no significant difference between the levosimendan group and the placebo group in rates of hypotension or cardiac arrhythmias.
Conclusions: In patients who required perioperative hemodynamic support after cardiac surgery, low-dose levosimendan in addition to standard care did not result in lower 30-day mortality than placebo. (Funded by the Italian Ministry of Health; CHEETAH ClinicalTrials.gov number, NCT00994825 .).
Source: PubMed