The use of levosimendan in cardiac surgery: an update after the LEVO-CTS, CHEETAH and LICORN trials in the light of clinical practice

Levosimendan is a calcium sensitizer and ATP-dependent potassium channel opener which exerts sustained hemodynamic, symptomatic and organ-protective effects. It is registered for the treatment of acute heart failure, and when inotropic support is considered appropriate. In the past fifteen years, levosimendan has been widely used in clinical practice, and has also been tested in clinical trials to stabilize at-risk patients undergoing cardiac surgery. Recently, three randomized, placebo-controlled, multicenter studies (LICORN, CHEETAH and LEVO-CTS) have been published reporting on the peri-operative use of levosimendan in patients with compromised cardiac ventricular function. Taken together, many smaller trials conducted in the past suggested beneficial outcomes with levosimendan in peri-operative settings. In contrast, the latest three studies were neutral or inconclusive. In order to understand the reasons for such dissimilarity, a group of experts from Austria, Belgium, Finland, France, Germany, Italy, Switzerland, and Russia, including investigators from the three most recent studies, met to discuss the study results in the light of both the previous literature and current clinical practice. Despite the fact that the null hypothesis could not be ruled out in the recent multicenter trials, we conclude that levosimendan can still be viewed as a safe and effective inodilator in cardiac surgery.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.