# Levosimendan vs. Intra-Aortic Balloon Pump in Coronary Artery Bypass Grafting: A Meta-Analysis

## TL;DR

This study compares levosimendan and intra-aortic balloon pumps in heart surgery, finding levosimendan improves recovery but may increase infection risk.

## Contribution

A meta-analysis comparing levosimendan and IABP in CABG surgery, revealing specific clinical outcomes and subgroup advantages.

## Key findings

- Levosimendan reduced ICU stay and hospital length of stay compared to IABP.
- Levosimendan improved mean arterial pressure levels in CABG patients.
- Higher but non-significant mediastinitis risk observed with levosimendan.

## Abstract

To compare the clinical efficacy and safety of intra-aortic balloon pump
(IABP) and levosimendan in coronary artery bypass grafting (CABG).

A systematic search of PubMed®, Embase, Cochrane Library, and Google
Scholar was conducted through July 2024. Outcomes analyzed included atrial
fibrillation, 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.

The analysis included nine studies with 681 patients. Levosimendan presented
advantage over IABP in CABG patients in terms of postoperative ICU stay,
postoperative length of stay, and reduction in MAP levels, with effect
sizes: mean difference (MD) = -0.83, 95% confidence interval (CI) -0.97 to
-0.68, P < 0.00001, MD = -1.14, 95% CI: -1.33 to -0.95, P < 0.00001,
and MD = -4.55, 95% CI: -6.14 to -2.96, P < 0.00001, respectively.
Levosimendan had an advantage on subgroup analyses in terms of postoperative
ICU stay and postoperative length of stay, with effect sizes: MD = -0.83,
95% CI: -0.93 to -0.72, P < 0.00001 and MD = -1.14, 95% CI: -1.28 to
-1.01, P < 0.00001, respectively. However, the incidence of postoperative
mediastinitis was higher in the levosimendan group (relative risk = 1.45,
95% CI: 0.88 to 2.38), though not statistically significant.

Levosimendan may improve recovery and hemodynamic outcomes in high-risk CABG
patients compared to IABP but may be associated with a higher, though
non-significant, risk of mediastinitis. Further high-quality studies are
warranted.