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Levosimendan: new indications and evidence for reduction in perioperative mortality?

Pisano, Antonio; Monti, Giacomo; Landoni, Giovanni

Current Opinion in Anaesthesiology: August 2016 - Volume 29 - Issue 4 - p 454–461
doi: 10.1097/ACO.0000000000000357
DRUGS IN ANESTHESIA: Edited by Jürgen Schüttler
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Purpose of review In the last years, the perioperative use of levosimendan in cardiac surgery patients is spreading. Moreover, newer indications have been suggested such as the treatment of sepsis-associated myocardial dysfunction. In the present review, we discuss the most recent evidences in these settings.

Recent findings Levosimendan has been seemingly confirmed to reduce mortality in patients undergoing cardiac surgery. In particular, it appears to be the only inotropic drug to have a favorable effect on survival in any clinical setting. Moreover, levosimendan has been shown to exert a cardioprotective action and to reduce acute kidney injury, renal replacement therapy, and ICU stay in cardiac surgery patients. Finally, levosimendan has been suggested to reduce mortality in patients with severe sepsis and to improve renal outcomes in critically ill patients.

Summary Although a strong rationale likely exists to use levosimendan in the setting of perioperative and critical care medicine, evidence mainly comes from small and often poor-quality randomized clinical trials, whose results acquire significance only when pooled in meta-analyses. Moreover, some aspects related to which subgroups of patients may derive the most benefits from receiving levosimendan, to the optimal timing of administration, and to the potential adverse effects need to be further clarified. Important insights will be hopefully provided soon by the several large multicenter investigations which are currently ongoing.

aCardiac Anesthesia and Intensive Care Unit, A.O.R.N. Dei Colli, Monaldi Hospital, Naples

bDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute

cVita-Salute San Raffaele University, Milan, Italy

Correspondence to Giovanni Landoni, MD, Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milano, 20132 Italy. Tel: +39 02 26436158; fax: +39 02 26436152; e-mail: landoni.giovanni@hsr.it

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