In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study (NCT02025621), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan.

B 5 Petrovsky Russian National Centre of Surgery Moscow Russia

Cardiothoracic Anaesthesiology and Intensive Care Department of Anaesthesiology and Intensive Care Medicine Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Anaesthesia and Critical Care Medicine Azienda Ospedaliero Universitaria Pisana Pisa Italy

Department of Anaesthesiology and Intensive Care Gottsegen György National Institute of Cardiology Budapest Hungary

Department of Anaesthesiology and Intensive Care Hôpital Européen Georges Pompidou AP HP Paris France; Université Paris Descartes Paris France

Department of Anaesthesiology and Intensive Care Kuopio University Hospital Kuopio Finland

Department of Anaesthesiology and Intensive Care Medicine University Hospital of Graz Graz Austria

Department of Anaesthesiology and Intensive Care Policlinico Umberto 1 La Sapienza University of Rome Rome Italy

Department of Anaesthesiology and Intensive Care Unit Aristotle University of Thessaloniki AHEPA Teaching Hospital Thessaloniki Greece

Department of Anaesthesiology and Intensive Care University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Anaesthesiology and Intensive Care University Hospital of Santiago de Compostela Santiago de Compostela Spain

Department of Anaesthesiology and Intensive Care University Hospital Split Split Croatia

Department of Anaesthesiology Intensive Care Emergency and Pain Medicine Helsinki University Hospital Helsinki Finland

Department of Anaesthesiology University of Lübeck Lübeck Germany

Department of Anaesthesiology UZ Leuven Campus Gasthuisberg Leuven Belgium

Department of Cardio Anaesthesiology University Clinical Centre Ljubljana Ljubljana Slovenia

Department of Cardio Anaesthesiology University Hospital Virgen de la Victoria de Malaga Malaga Spain

Department of Cardiothoracic Surgery Karolinska University Hospital Solna Stockholm Sweden

Department of Cardiothoracic Surgery Skånes University Hospital Lund Lund Sweden

Department of Critical Care St Thomas' Hospital London UK

Department of Internal Medicine and Cardiology Duke University Medical Center and Duke Clinical Research Institute Durham NC USA

E N Meshalkin State Novosibirsk Research Institute of Circulation Pathology Novosibirsk Russia

Heart Centre and Intensive Care Unit Tampere University Hospital Tampere Finland

Heart Failure Unit Rabin Medical Centre Petach Tikva Israel

Institute of Anaesthesiology University Hospital of Zürich Zürich Switzerland

Orion Pharma Critical Care Espoo Finland

References provided by Crossref.org

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

See more in PubMed

ClinicalTrials.gov
NCT02025621