levosimendan vs intra-aortic balloon pump.rm5

Abstract:Aims: In this meta-analysis, IABP and levosimendan were compared for their clinical efficacy and safety during coronary artery bypass grafting (CABG).Methods: We carefully searched clinical trials on the use of levosimendan and IABP support in adult patients having CABG from the beginning of the database until January 2023 in PubMed, Embase, Cochrane Database of Clinical Trials, and Google Scholar. Atrial fibrillation (AF), postoperative mediastinitis, the requirement for inotropic support, in-hospital mortality, postoperative intensive care unit (ICU) stay, postoperative length of stay, ventilation time, and mean arterial pressure (MAP) levels were the main outcomes in this meta-analysis. The RevMan 5.4 program was used for meta-analysis, and publication bias was examined using funnel plot analysis.Results: The final analysis included eleven articles with a total of 769 patients, including 380 patients in the IABP group and 389 patients in the levosimendan group. Compared with IABP, levosimendan provided a significant advantage in CABG patients in terms of postoperative ICU stay, postoperative length of stay, and reduction in mean pulsatile pulse pressure, with effect sizes of (MD = - 0.83, 95% CI: - 0.98 to -0.69, P < 0. 00001), (MD = - 1.14, 95% CI: - 1.33 to -0.95, P < 0. 00001), and (MD = - 4.45, 95% CI: - 5.94 to - 2.00, P < 0.00001), respectively. Subgroup analyses showed differences in outcomes across subgroups. The ICU length of stay in the levosimendan group had effect sizes of (MD = - 0.91, 95% CI: - 1.06 to - 0.75, P < 0.00001) and (MD = - 0.89, 95% CI: - 1.04 to - 0.74, P < 0.00001) in the subgroups of the randomized controlled trial (RCT) and age < 60 years, respectively. In terms of postoperative length of hospital stay, the levosimendan group in the age ≥ 60 years subgroup had an effect size of (MD = - 2.50, 95% CI: - 2.84 to - 2.17, P < 0.00001). In the AF incidence, the levosimendan group may have had an advantage in the age ≥ 60 years subgroup (RR = 0.33, 95% CI: 0.15 to 0.75, P = 0.008).Conclusion: In patients with CABG, levosimendan showed advantages compared to IABP in postoperative ICU length of stay, postoperative length of stay and MAP levels.