{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:22:11Z","timestamp":1760149331111,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Postoperative myocardial dysfunction following cardiac surgery is a relatively common occurrence. Levosimendan, a calcium sensitizer and inotropic drug, has shown potential in improving outcomes for patients with low preoperative ejection fraction (EF) and myocardial dysfunction after cardiac surgery. This study aims to evaluate the efficacy of levosimendan in optimizing the surgical outcome for such patients. Methods: A retrospective analysis was conducted on 314 patients with preoperative severe heart failure who underwent cardiac surgery. Among them, 184 patients received perioperative adjunctive therapy with levosimendan, while a comparable group of 130 patients received conventional treatment. Results: The use of levosimendan demonstrated several advantages in postoperative outcomes. It significantly improved short- and long-term survival rates after cardiac surgery, enhanced hemodynamic stability, reduced the requirement for inotropic support, and facilitated faster weaning from ventilator support. Patients who received levosimendan reported reduced angina and dyspnea symptoms, as well as fewer postoperative arrhythmias. Furthermore, levosimendan helped minimize myocardial injury inevitable after cardiac surgery. The levosimendan group also exhibited a notable reduction in hospital readmissions. Conclusions: This study provides evidence of several benefits associated with the perioperative use of levosimendan. However, further prospective randomized studies are warranted to standardize and comprehensively document the other perioperative therapies, in order to validate these findings and establish stronger conclusions.<\/jats:p>","DOI":"10.3390\/jcdd10080332","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T11:13:06Z","timestamp":1691061186000},"page":"332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Perioperative Use of Levosimendan as a Means of Optimizing the Surgical Outcome in Patients with Severe Heart Insufficiency Undergoing Cardiac Surgery"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-0059","authenticated-orcid":false,"given":"Vasileios","family":"Leivaditis","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Grapatsas","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5479-4649","authenticated-orcid":false,"given":"Anastasia","family":"Papaporfyriou","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Internal Medicine II, Vienna University Hospital, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8599-044X","authenticated-orcid":false,"given":"Michail","family":"Galanis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Inselspital\u2014Bern University Hospital, University of Bern, 3012 Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-4047","authenticated-orcid":false,"given":"Efstratios","family":"Koletsis","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Charokopos","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Haussmann","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladislav","family":"Kaplunov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanasios","family":"Papatriantafyllou","sequence":"additional","affiliation":[{"name":"Department of General Surgery, General Hospital of Patras \u201cAgios Andreas\u201d, 26332 Patras, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Dahm","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/CCM.0b013e318232962a","article-title":"Effects of levosimendan on mortality and hospitalization. A meta-analysis of randomized controlled studies*","volume":"40","author":"Landoni","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"R140","DOI":"10.1186\/cc10263","article-title":"Levosimendan and mortality after coronary revascularisation: A meta-analysis of randomised controlled trials","volume":"15","author":"Maharaj","year":"2011","journal-title":"Crit. Care"},{"key":"ref_3","first-page":"125","article-title":"Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass","volume":"17","author":"Levin","year":"2012","journal-title":"Exp. Clin. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s13054-017-1848-1","article-title":"Effect of levosimendan on prognosis in adult patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials","volume":"21","author":"Chen","year":"2017","journal-title":"Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1093\/bja\/aev284","article-title":"The Effect of inotropes and vasopressors on mortality: A meta-analysis of randomized clinical trials","volume":"115","author":"Belletti","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_6","first-page":"7563083","article-title":"Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery: An Update Meta-Analysis and Trial Sequential Analysis","volume":"2018","author":"Wang","year":"2018","journal-title":"BioMed Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/jocs.13716","article-title":"Effects of levosimendan on mortality in patients undergoing cardiac surgery: A systematic review and meta-analysis","volume":"33","author":"Chen","year":"2018","journal-title":"J. Card. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1093\/icvts\/ivy017","article-title":"Effect of levosimendan on clinical outcomes in adult patients undergoing cardiac surgery: A meta-analysis of randomized controlled trials","volume":"26","author":"Zhou","year":"2018","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/FJC.0000000000000584","article-title":"Perioperative Use of Levosimendan Improves Clinical Outcomes in Patients After Cardiac Surgery: A Systematic Review and Meta-Analysis","volume":"72","author":"Qiang","year":"2018","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jclinane.2018.08.019","article-title":"Levosimendan use in patients with preoperative low ejection fraction undergoing cardiac surgery: A systematic review with meta-analysis and trial sequential analysis","volume":"52","author":"Ng","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Chen, W.-C., Lin, M.-H., Chen, C.-L., Chen, Y.-C., Chen, C.-Y., Lin, Y.-C., and Hung, C.-C. (2021). Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials. J. Clin. Med., 10.","DOI":"10.3390\/jcm10051032"},{"key":"ref_12","first-page":"2092","article-title":"Levosimendan improves postoperative heart function recovery and prognosis in patients with heart disease","volume":"14","author":"Liu","year":"2022","journal-title":"Am. J. Transl. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101107","DOI":"10.1016\/j.accpm.2022.101107","article-title":"Prophylactic levosimendan in patients with low ejection fraction undergoing coronary artery bypass grafting: A pooled analysis of two multicentre randomised controlled trials","volume":"41","author":"Caruba","year":"2022","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_14","first-page":"219","article-title":"Preoperative usages of levosimendan in patients undergoing coronary artery bypass grafting","volume":"7","author":"Eris","year":"2014","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.2147\/DDDT.S160092","article-title":"Assessment of the effects of levosimendan and thymoquinone on lung injury after myocardial ischemia reperfusion in rats","volume":"12","author":"Sezen","year":"2018","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"402","DOI":"10.4070\/kcj.2016.46.3.402","article-title":"Levosimendan Reduces Lung Injury in a Canine Model of Cardiopulmonary Bypass","volume":"46","author":"Feng","year":"2016","journal-title":"Korean Circ. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/jocs.12562","article-title":"Levosimendan Reduces Mortality in Adults with Left Ventricular Dysfunction Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis","volume":"30","author":"Lim","year":"2015","journal-title":"J. Card. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"859.e1","DOI":"10.1016\/j.jcrc.2015.03.008","article-title":"Early levosimendan administration is associated with decreased mortality after cardiac surgery","volume":"30","author":"Treskatsch","year":"2015","journal-title":"J. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"94","DOI":"10.4103\/0971-9784.109737","article-title":"Effect of levosimendan on hemodynamic changes in patients undergoing off-pump coronary artery bypass grafting: A randomized controlled study","volume":"16","author":"Karthekeyan","year":"2013","journal-title":"Ann. Card. Anaesth."},{"key":"ref_20","first-page":"80","article-title":"Haemodynamic effects of levosimendan for low cardiac output after cardiac surgery: A case series","volume":"48","author":"Malliotakis","year":"2007","journal-title":"Hell. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1093\/bja\/aen367","article-title":"Levosimendan pre-treatment improves outcomes in patients undergoing coronary artery bypass graft surgery","volume":"102","author":"Tritapepe","year":"2009","journal-title":"Br. J. Anaesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/clc.22230","article-title":"Management of Postoperative Atrial Fibrillation and Subsequent Outcomes in Contemporary Patients Undergoing Cardiac Surgery: Insights From the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry","volume":"37","author":"Steinberg","year":"2013","journal-title":"Clin. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E287","DOI":"10.1532\/HSF98.2013190","article-title":"Levosimendan Use Decreases Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting: A Pilot Study","volume":"16","author":"Abacilar","year":"2013","journal-title":"Hear. Surg. Forum"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1053\/j.jvca.2008.02.019","article-title":"RETRACTED: A Randomized Trial Evaluating Different Modalities of Levosimendan Administration in Cardiac Surgery Patients With Myocardial Dysfunction","volume":"22","author":"Lorsomradee","year":"2008","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/ALN.0b013e3181ab6743","article-title":"Moderate exposure to allogeneic blood products is not associated with reduced long-term survival after surgery for coronary artery disease","volume":"111","author":"Weightman","year":"2009","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1053\/j.jvca.2012.02.006","article-title":"Efforts to change transfusion practice and reduce transfusion rates are effective in coronary artery bypass surgery","volume":"26","author":"Andreasen","year":"2012","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1053\/j.jvca.2008.11.013","article-title":"Levosimendan Reduces Cardiac Troponin Release After Cardiac Surgery: A Meta-analysis of Randomized Controlled Studies","volume":"23","author":"Zangrillo","year":"2009","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1161\/01.CIR.102.11.1216","article-title":"It\u2019s Time for a Change to a Troponin Standard","volume":"102","author":"Jaffe","year":"2000","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/00000542-200308000-00007","article-title":"Short- and Long-term Prognostic Value of Postoperative Cardiac Troponin I Concentration in Patients Undergoing Coronary Artery Bypass Grafting","volume":"99","author":"Fellahi","year":"2003","journal-title":"Anesthesiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1161\/CIRCULATIONAHA.105.602370","article-title":"Relationship Between Postoperative Cardiac Troponin I Levels and Outcome of Cardiac Surgery","volume":"114","author":"Croal","year":"2006","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0022-5223(97)70208-3","article-title":"Troponin I release during minimally invasive coronary artery surgery","volume":"114","author":"Birdi","year":"1997","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0009-8981(01)00556-3","article-title":"Utility of cardiac troponin measurement after cardiac surgery","volume":"311","author":"Dehoux","year":"2001","journal-title":"Clin. Chim. Acta"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1378\/chest.118.2.342","article-title":"Evaluation of Myocardial Injury Following Repeated Internal Atrial Shocks by Monitoring Serum Cardiac Troponin I Levels","volume":"118","author":"Boriani","year":"2000","journal-title":"Chest"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/8\/332\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:24:58Z","timestamp":1760127898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/8\/332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcdd10080332"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10080332","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,8,3]]}}}