The role of prophylactic levosimendan in coronary surgery has not been established conclusively.

Postoperative outcomes of 139 patients (mean age, 68.2±9.6 years) having preoperative left ventricular ejection fraction (LVEF) ≤40% and undergoing isolated coronary surgery (2013-2017) were reviewed retrospectively. In 42 (30.2%) patients (L-group), an intravenous infusion of levosimendan was started 24 hours before operation. The remaining 97 (69.8%) patients were the control group (C-group). A comparison between the two groups regarding outcome of surgery was performed also after propensity matching.

Although the risk profile in L-patients was higher than in C-patients (median European System for Cardiac Operative Risk Evaluation II, 10.5% vs. 6.5%, P=0.013) due to higher prevalence of New York Heart Association class III-IV, LVEF ≤30%, and preoperative intra-aortic balloon pump, in-hospital mortality was equivalent (4.8% vs. 3.1%, P=0.48). However, low cardiac output, multiple blood transfusion, and any major complication early after surgery were more frequent in L-patients. After one-to-one propensity matching, which resulted in 15 pairs with similar baseline characteristics the use of levosimendan was associated with a trend towards an increased blood use (P=0.077), a higher frequency of any major complication (P=0.053), and lower peak serum levels of cardiac troponin I (P=0.088). No intergroup differences concerning mid-term survival or outcomes were found even for matched patients.

When compared with traditional inotropes alone, prophylactic use of levosimendan showed clear benefits/drawbacks neither concerning immediate nor mid-term outcomes after coronary surgery. There could be any advantage in terms of myocardial preservation.