Effect of levosimendan on survival and adverse events after cardiac surgery: a meta-analysis.
J Cardiothorac Vasc Anesth
; 27(6): 1224-32, 2013 Dec.
Article
em En
| MEDLINE
| ID: mdl-24050857
ABSTRACT
OBJECTIVE:
Left ventricular systolic dysfunction is associated with increased morbidity and mortality in patients undergoing cardiac surgery. The authors performed a meta-analysis investigating the effects of levosimendan in cardiac surgery patients with and without preoperative systolic dysfunction.DESIGN:
Meta-analysis of randomized controlled trials.SETTING:
Hospital.PARTICIPANTS:
The 1,155 patients who participated in 14 randomized controlled trials of perioperative levosimendan were included.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
PubMed, EMBASE, the Cochrane database of clinical trials, and conference proceedings were searched for clinical trials of perioperative levosimendan in patients undergoing cardiac surgery through May 1, 2012. Studies were grouped by mean ejection fraction (EF). Those with a mean EF <40% were designated as low-EF. Pooled results demonstrated a reduction in mortality with levosimendan (risk difference [RD]-4.2%; 95% CI -7.2%, -1.1%; p = 0.008). Subgroup analysis showed that this benefit was confined to the low-EF studies (RD -7.0%; 95% CI -11.0%, -3.1%; p < 0.001). No benefit was observed in the preserved-EF subgroup (RD +1.1%; 95% CI -3.8%, +5.9%; p = 0.66). Significant reductions also were seen in the need for dialysis (RD -4.9%; 95% CI -8.2%, -1.6%; p = 0.003), myocardial injury (RD -5.0%; 95% CI -8.3%, -1.7%; p = 0.003), and postoperative atrial fibrillation (RD -8.1%; 95% CI -13.3%, -3.0%; p = 0.002).CONCLUSIONS:
Levosimendan was associated with reduced mortality and other adverse outcomes in patients undergoing cardiac surgery, and these benefits were greatest in patients with reduced EF. These data support the need for adequately powered randomized clinical trials to confirm the benefits of levosimendan in patients with reduced EF undergoing cardiac surgery.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
/
Piridazinas
/
Cardiotônicos
/
Procedimentos Cirúrgicos Cardíacos
/
Hidrazonas
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
J Cardiothorac Vasc Anesth
Assunto da revista:
ANESTESIOLOGIA
/
CARDIOLOGIA
Ano de publicação:
2013
Tipo de documento:
Article