A related editorial discusses these results, and the results of another study investigating the use of levosimendan in patients with left ventricular systolic dysfunction undergoing cardiac surgery requiring cardiopulmonary bypass which also failed to meet its primary endpoint.
Overall, these data suggest that despite its unique mechanism of action, levosimendan has no clear advantage over conventional inotropic drugs for the management of perioperative low cardiac output syndrome in patients undergoing cardiac surgery. By highlighting the lack of a clear incremental advantage to levosimendan over routine care with the use of existing agents, these trials collectively challenge the previous endorsement of levosimendan use in the European literature and argue against the approval of levosimendan for this indication.