الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
P
atients undergoing open heart surgery with cardiopulmonary bypass (CPB) experience global perioperative heart ischemia followed by reperfusion. This leads to different degrees of myocardial dysfunction due to free radical formation, impairment of the coronary vasculature and calcium overload. If severe enough this can cause postoperative low cardiac output syndrome (LCOS), a life-threatening complication with a prevalence of about 10% and a mortality of 17%.
The purpose of our study was to study the efficiency of levosimendan in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass.
This meta-analysis will be performed according to PRISMA statement. Databases searched will include Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews. Search keywords were extracted from initially retrieved articles and comprised ―levosimendan‖ and ―cardiac surgery‖ using the Boolean search operator AND.
Results showed levosimendan use was associated with lower risk of low cardiac output syndrome and renal injury and/or renal replacement therapy. Levosimendan use was also associated with marker lower risk of perioperative mortality. However, this effect marginally fell short of statistical significance. No significant differences were noted between levosimendan use and control regarding postoperative myocardial infarction, hypotension or atrial fibrillation.
As previously stressed, studies included in this meta-analysis were conducted only on patients with severe left ventricular dysfunction (LVEF≤ 35.0 %). In fact, only 2 published meta-analyses included studies with similar degree of ventricular dysfunction. Sanfilippo et al. (2107) work on 5 studies including 1224 patients, the authors concluded that levosimendan administration was associated with significant reduction in mortality rate. They also noted that levosimendan use was associated with lower rate of renal replacement therapy and low cardiac output syndrome. In another work, Weber et al. (2020) meta-analysis found that levosimendan was associated with lower mortality and lower rates of LCOS and acute kidney injury.
In conclusion, the present meta-analysis found that levosimendan administration is related to better in-hospital survival and lower rates of low cardiac output syndrome and renal injury and/or renal replacement therapy in patients with severe left ventricular dysfunction submitted to cardiac surgery. So, use levosimendan is strongly advised in those patients.
CONCLUSION AND RECOMMENDATIONS
T
he present meta-analysis concludes that levosimendan administration is related to better in-hospital survival and lower rates of low cardiac output syndrome and renal injury and/or renal replacement therapy in patients with severe left ventricular dysfunction submitted to cardiac surgery. So, use levosimendan is strongly advised in those patients.
However, well-designed randomized controlled studies conducted on this particular group of patients are scare. For build up of rigorous clinical evidence, it recommended to perform more studies with more prolonged follow up and larger sample size.