Preconditioning with levosimendan reduces postoperative low cardiac output in moderate-severe systolic dysfunction patients who will undergo elective coronary artery bypass graft surgery: a cost-effective strategy

J Cardiothorac Surg. 2020 May 24;15(1):108. doi: 10.1186/s13019-020-01140-z.

Abstract

Background: Patients with moderate-severe systolic dysfunction undergoing coronary artery bypass graft have a higher incidence of postoperative low cardiac output. Preconditioning with levosimendan may be a useful strategy to prevent this complication. In this context, design cost-effective strategies like preconditioning with levosimendan may become necessary.

Methods: In a sequential assignment of patients with Left Ventricle Ejection Fraction less than 40%, two strategies were compared in terms of cost-effectiveness: standard care (n = 41) versus preconditioning with Levosimendan (n = 13). The adverse effects studied included: postoperative new-onset atrial fibrillation, low cardiac output, renal failure and prolonged mechanical ventilation. The costs were evaluated using deterministic and probabilistic sensitivity analysis, and Monte Carlo simulations were performed.

Results: Preconditioning with levosimendan in moderate to severe systolic dysfunction (Left Ventricle Ejection Fraction < 40%), was associated with a lower incidence of postoperative low cardiac output in elective coronary artery bypass graft surgery 2(15.4%) vs 25(61%) (P < 0.01) and lesser intensive care unit length of stay 2(1-4) vs 4(3-6) days (P = 0.03). Average cost on levosimendan group was 14,792€ while the average cost per patient without levosimendan was 17,007€. Patients with no complications represented 53.8% of the total in the levosimendan arm, as compared to 31.7% in the non-levosimendan arm. In all Montecarlo simulations for sensitivity analysis, use of levosimendan was less expensive and more effective.

Conclusions: Preconditioning with levosimendan, is a cost-effective strategy preventing postoperative low cardiac output in patients with moderate-severe left ventricular systolic dysfunction undergoing elective coronary artery bypass graft surgery.

Keywords: Cardiac surgery; Coronary artery bypass graft; Cost-effectiveness; Levosimendan; Low cardiac output; Preconditioning.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cardiac Output, Low / epidemiology
  • Cardiac Output, Low / etiology
  • Cardiac Output, Low / prevention & control*
  • Cardiotonic Agents / pharmacology
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Bypass / economics
  • Coronary Artery Disease / surgery
  • Cost-Benefit Analysis
  • Elective Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Incidence
  • Male
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Simendan / pharmacology*
  • Spain / epidemiology
  • Stroke Volume / drug effects
  • Stroke Volume / physiology*
  • Ventricular Function, Left / drug effects
  • Ventricular Function, Left / physiology*

Substances

  • Cardiotonic Agents
  • Simendan