Eur J Cardiothorac Surg. 2023 Mar 13:ezad095. doi: 10.1093/ejcts/ezad095. Online ahead of print.
INTRODUCTION: Early right heart failure (RHF) was seen in 22% of left ventricular assist device (LVAD) recipients in the European registry for patients with mechanical circulatory support (EUROMACS). However, the optimal treatment of post-LVAD RHF is not well known. Levosimendan has proven to be effective in cardiogenic shock patients, and in end-stage heart failure patients. We sought to evaluate the efficacy of levosimendan on post-LVAD RHF and 30-day and 1-year mortality.
METHODS: The EUROMACS Registry was used to identify adults with mainstream continuous-flow LVAD implantation treated with preoperative levosimendan compared to a propensity-matched control cohort.
RESULTS: In total, 3661 patients received mainstream LVAD, of which 399(11%) were treated with pre-LVAD levosimendan. Levosimendan patients had a higher EUROMACS RHF score [4 (2- 5.5) vs 2 (2- 4); p < 0.001], received more right ventricular assist device (RVAD) [32(8%) vs 178(5.5%); p = 0.038] and stayed longer in the ICU post-LVAD implantation [19 (8- 35) vs 11(5- 25); p < 0.001]. Yet, there was no significant difference in the rate of RHF, 30-day, or 1-year mortality. Also, in the matched cohort (357 levosimendan patients to an average of 622 controls across 20 imputations), we found no evidence for a difference in postoperative severe RHF, RVAD implantation rate, length of ICU stay, or 30-days and 1-year mortality.
CONCLUSION: In this analysis of the EUROMACS Registry, we found no evidence for an association between levosimendan and early RHF or mortality, albeit, levosimendan patients had much higher risk profile. For a definitive conclusion, a multicenter, randomised study is warranted.