Use of Levosimendan in Adult Patients with Postcardiotomy Extracorporeal Life Support: A Single-Center Experience

Objectives: Currently, treatment of heart failure patients with levosimendan (LEV) is critically discussed. This study evaluates the benefit of LEV in patients with postcardiotomy failure requiring ECLS.

Methods: Between March 2006 and December 2018, a total of 261 patients received ECLS support after cardiac surgery, of whom 106 entered the study after excluding patients with resuscitation, VAD or heart transplantation. 66 patients treated with levosimendan were compared with 40 patients with standard inotropic therapy (control group) in a retrospective analysis.

Result: In the whole patient cohort, indication for ECLS was weaning failure in 65.1% (n = 69), and postoperative low output (without resuscitation) in 34.9%. In the levosimendan group, successful weaning was noted in 74.2% (n = 49), 4.5% (n = 3) received transplantation/VAD, and 100-day survival was 36.8% (n = 35). In the control group, 18 patients (45%; p = 0.007) were weaned from support, two received transplantation/VAD (5%), and 100-day survival was 30.0% (n = 12; p = 0.007). There was no significant difference in postoperative complications. Risk factor analysis demonstrated a higher incidence of preoperative myocardial infarction (LEV vs. control 28.8% vs. 10%; p = 0.023), and a longer duration of ECLS support (LEV vs control 6.47 vs 4.00 days; p < 0.001) in the LEV group, whereas preoperative left ventricular ejection fraction was comparable (LEV vs control 43.1 vs. 45.8%).

Conclusion: Treatment with levosimendan may have a positive impact on the weaning rate and outcome of patients with postcardiotomy failure and ECLS support.

Publication History

Article published online:
19 February 2021