Levosimendan reduces cardiac troponin release after cardiac surgery: a meta-analysis of randomized controlled studies

Objectives: The authors performed a meta-analysis to investigate the effects of levosimendan in cardiac surgery. Inotropic drugs have never shown beneficial effects on outcome in randomized controlled studies, with the possible exception of levosimendan. Design: A meta-analysis. Setting: Hospitals. Participants: A total of 139 patients from 5 randomized controlled studies were included in the analysis. Interventions: None. Measurments and Main Results: Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment, and comparison of levosimendan versus control performed on cardiac surgery patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoint was postoperative cardiac troponin release. Levosimendan was associated with a significant reduction in cardiac troponin peak release (weighted mean difference = 2.5 ng/dL [-3.86, -1.14], p = 0.0003) and in time to hospital discharge (weighted mean difference = -1.38 days [-2.78, 0.03], p = 0.05). No other relevant outcome (mortality, myocardial infarction, atrial fibrillation, time on mechanical ventilation, and intensive care unit stay) was improved in those patients receiving levosimendan. Conclusions: Levosimendan has cardioprotective effects, resulting in reduced postoperative cardiac troponin release. (C) 2009 Elsevier Inc. All rights reserved