Exploring the role of prophylactic levosimendan in coronary surgery

Background:The role of prophylactic levosimendan in coronary surgery has not been established conclusively.Methods:Postoperative outcomes of 139 patients(mean age,68.2±9.6 years)having preoperative left ventricular ejection fraction(LVEF)≤40%and undergoing isolated coronary surgery(2013-2017)were reviewed retrospectively.In 42(30.2%)patients(L-group),an intravenous infusion of levosimendan was started 24 hours before operation.The remaining 97(69.8%)patients were the control group(C-group).A comparison between the two groups regarding outcome of surgery was performed also after propensity matching.Results:Although the risk profile in L-patients was higher than in C-patients(median European System for Cardiac Operative Risk Evaluation II,10.5%vs.6.5%,P=0.013)due to higher prevalence of New York Heart Association class III-IV,LVEF≤30%,and preoperative intra-aortic balloon pump,in-hospital mortality was equivalent(4.8%vs.3.1%,P=0.48).However,low cardiac output,multiple blood transfusion,and any major complication early after surgery were more frequent in L-patients.After one-to-one propensity matching,which resulted in 15 pairs with similar baseline characteristics the use of levosimendan was associated with a trend towards an increased blood use(P=0.077),a higher frequency of any major complication(P=0.053),and lower peak serum levels of cardiac troponin I(P=0.088).No intergroup differences concerning mid-term survival or outcomes were found even for matched patients.Conclusions:When compared with traditional inotropes alone,prophylactic use of levosimendan showed clear benefits/drawbacks neither concerning immediate nor mid-term outcomes after coronary surgery.There could be any advantage in terms of myocardial preservation.