Left ventricular dysfunction following cardiac surgery remains a significant perioperative challenge, one often treated with inotropic support, however practice patterns vary widely and there are few outcome data to support a standardized practice. Levosimendan represents a newer class of \u201cinodilators\u201d, calcium sensitizers, thought to improve cardiac output without increasing myocardial oxygen consumption.<\/p>\n
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In the Levosimendan to Reduce Mortality in High Risk Cardiac Surgery Patients (CHEETAH) randomized trial, 506 patients with a preoperative ejection fraction < 25%, a preoperative need for \u00a0intraaortic balloon pump (IABP) support, or post-operative need for support with IABP or high-dose inotropes within 24 hours of cardiopulmonary bypass were randomized 1:1 to receive either levosimendan infusion or placebo plus standard medical therapy in a double-blinded fashion.<\/p>\n
The primary outcome of the study was 30-day mortality. No difference in the primary outcome was found between the levosimendan group (12.9% mortality) and the placebo group (12.8% mortality) (ARR 0.1%, CI -5.7-5.9, P 0.97), leading to early interruption of the trial for futility. There were also no significant differences in secondary outcomes or adverse events.<\/p>\n
Notably the mean levosimendan dose was 0.066 +\/- 0.031 mcg\/kg\/min, lower than all previous trials which used at least 0.1 mcg\/kg\/min.<\/p>\n