Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis.

Terbeck, Sandra; Heinisch, Paul Philipp; Lenz, Armando; Friess, Jan-Oliver; Günsch, Dominik; Carrel, Thierry; Eberle, Balthasar; Erdös, Gabor (2019). Levosimendan and systemic vascular resistance in cardiac surgery patients: a systematic review and meta-analysis. Scientific Reports, 9(1), p. 20343. Nature Publishing Group 10.1038/s41598-019-56831-y

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Levosimendan is a potent non-adrenergic inodilator agent. The net effect of hemodynamic changes may result in a hyperdynamic state with low systemic vascular resistance. We conducted a systematic review and meta-analysis assessing hemodynamics in cardiac surgery patients treated with levosimendan. English-language literature was searched systematically from 2006 until October 2018, including randomized controlled trials and case-matched or retrospective studies providing at least two sequentially measured hemodynamic variables in adult patients who underwent cardiac surgery with cardiopulmonary bypass and were treated with levosimendan in comparison to alternative drugs or devices. Cardiac index significantly increased in the levosimendan group by 0.74 (0.24 to 1.23) [standardized mean difference (95% CI); p = 0.003] from baseline to postoperative day (POD) 1, and by 0.75 (0.25 to 1.25; p = 0.003) from baseline to POD 7, when corrected for the standardized mean difference at baseline by a multivariate mixed effects meta-analysis model. With this correction for baseline differences, other hemodynamic variables including systemic vascular resistance did not significantly differ until POD 1 [-0.17 (-0.64 to 0.30), p = 0.48] and POD 7 [-0.13 (-0.61 to 0.34), p = 0.58] between the levosimendan and the comparator group. Levosimendan increases cardiac index in patients undergoing cardiac surgery. Although levosimendan has inodilator properties, this meta-analysis finds no clinical evidence that levosimendan produces vasopressor-resistant vasoplegic syndrome.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Terbeck, Sandra, Heinisch, Paul Philipp, Lenz, Armando, Friess, Jan-Oliver, Günsch, Dominik, Carrel, Thierry, Eberle, Balthasar, Erdoes, Gabor (A)


600 Technology > 610 Medicine & health




Nature Publishing Group




Jeannie Wurz

Date Deposited:

09 Jan 2020 14:13

Last Modified:

20 Feb 2024 14:16

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