Table_3_Effect of Prophylactic Levosimendan on All-Cause Mortality in Pediatric Patients Undergoing Cardiac Surgery—An Updated Systematic Review and Meta-Analysis.DOC

Background: Levosimendan, a calcium sensitizer, enhances the myocardial function by generating more energy-efficient myocardial contractility than that achieved through adrenergic stimulation with catecholamines. We conducted this meta-analysis to primarily investigate the effects of levosimendan on all-cause mortality in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass.
Methods: The databases of Pubmed, Embase, and Cochrane Library were searched till 21st March 2020. The eligible criteria were participants with age<18 year and undergoing cardiac surgery for congenital heart disease (CHD), and studies of comparison between levosimendan and placebo or other inotropes. Stata version 12.0 was used to perform statistical analyses.
Results: Six randomized controlled trials (RCTs) and 1 case–control trial (CCT) including 436 patients were included. The results showed that levosimendan did not significantly decrease all-cause mortality compared with control drugs (and placebo) in children undergoing cardiac surgery (P = 0.403). Perioperative prophylactic levosimendan administration strikingly decreased the low cardiac output syndrome (LCOS) incidence (P = 0.016) but did not significantly reduce acute kidney injury (AKI) incidence (P = 0.251) and shorten mechanical ventilation and ICU stay time compared with other inotropes and placebo by analyzing the included literatures [mechanical ventilation (or intubation) time: P = 0.188; ICU stay time: P = 0.620].
Conclusions: Compared with other inotropes and placebo, perioperative prophylactic administration of levosimendan did not decrease the rates of mortality and AKI and shorten the time of mechanical ventilation (or intubation) and ICU stay but demonstrated a significant reduction in LCOS incidence after corrective surgery in pediatric patients for CHD. Due to limited number of included studies, the current data were insufficient to make the conclusions.

背景：左西孟旦（Levosimendan）作为一种钙增敏剂，相较于儿茶酚胺类药物介导的肾上腺素能刺激，其可通过生成能量效率更高的心肌收缩力来增强心肌功能。本研究开展此项荟萃分析，首要探讨左西孟旦对体外循环下接受心脏手术的儿科患者全因死亡率的影响。
方法：检索PubMed、Embase及Cochrane Library数据库，检索时限截至2020年3月21日。纳入标准为年龄<18岁、因先天性心脏病（CHD）接受心脏手术的受试者，以及对比左西孟旦与安慰剂或其他正性肌力药物的研究。采用Stata 12.0版本进行统计学分析。
结果：共纳入6项随机对照试验（RCTs）及1项病例对照试验（CCT），涉及436例患者。结果显示，相较于对照药物（含安慰剂），左西孟旦并未显著降低先天性心脏病患儿心脏手术后的全因死亡率（P=0.403）。对纳入文献的分析表明，与其他正性肌力药物及安慰剂相比，围术期预防性应用左西孟旦可显著降低低心排血量综合征（LCOS）的发生率（P=0.016），但未显著减少急性肾损伤（AKI）的发生率（P=0.251），亦未缩短机械通气时间与ICU停留时间[机械通气（或气管插管）时间：P=0.188；ICU停留时间：P=0.620]。
结论：相较于其他正性肌力药物及安慰剂，围术期预防性应用左西孟旦并未降低先天性心脏病矫治手术患儿的死亡率与急性肾损伤发生率，也未缩短机械通气（或气管插管）时间及ICU停留时间，但可显著降低术后低心排血量综合征的发生率。鉴于纳入研究数量有限，现有数据尚不足以支撑上述结论。