TY - JOUR
T1 - Levosimendan for Hemodynamic Support after Cardiac Surgery
AU - Landoni, Giovanni
AU - Lomivorotov, Vladimir V.
AU - Alvaro, Gabriele
AU - Lobreglio, Rosetta
AU - Pisano, Antonio
AU - Guarracino, Fabio
AU - Calabrò, Maria G.
AU - Grigoryev, Evgeny V.
AU - Likhvantsev, Valery V.
AU - Salgado-Filho, Marcello F.
AU - Bianchi, Alessandro
AU - Pasyuga, Vadim V.
AU - Baiocchi, Massimo
AU - Pappalardo, Federico
AU - Monaco, Fabrizio
AU - Boboshko, Vladimir A.
AU - Abubakirov, Marat N.
AU - Amantea, Bruno
AU - Lembo, Rosalba
AU - Brazzi, Luca
AU - Verniero, Luigi
AU - Bertini, Pietro
AU - Scandroglio, Anna M.
AU - Bove, Tiziana
AU - Belletti, Alessandro
AU - Michienzi, Maria G.
AU - Shukevich, Dmitriy L.
AU - Zabelina, Tatiana S.
AU - Bellomo, Rinaldo
AU - Zangrillo, Alberto
N1 - Publisher Copyright:
© Copyright 2017 Massachusetts Medical Society. All rights reserved.
PY - 2017/5/25
Y1 - 2017/5/25
N2 - 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.).
AB - 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.).
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U2 - 10.1056/NEJMoa1616325
DO - 10.1056/NEJMoa1616325
M3 - Article
C2 - 28320259
AN - SCOPUS:85019861977
SN - 0028-4793
VL - 376
SP - 2021
EP - 2031
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 21
ER -