Levosimendan in postcardiotomy cardiogenic shock: A single-center retrospective cohort study

Background: Postcardiotomy cardiogenic shock remains an uncommon but highly lethal complication after cardiac surgery. Levosimendan, a calcium-sensitizing inodilator, may improve hemodynamics and organ perfusion without increasing myocardial oxygen demand. This study aimed to describe levosimendan use in our practice and to explore its association with early postoperative outcomes.
Methods: We conducted a single-center retrospective study in the polyvalent intensive care unit of Hassan II University Hospital, Fez, from January 2024 to January 2025. Among 86 adult cardiac surgery patients, 77 were analyzed after exclusion of 9 incomplete records. Eleven patients received levosimendan for immediate postcardiotomy cardiogenic shock; 66 non-exposed patients from the same period formed an exploratory comparator cohort. Outcomes included ventilator weaning, renal function, inotropic support evolution, arrhythmias, ICU length of stay, serial left ventricular ejection fraction (LVEF), and 30-day mortality.
Results: Patients receiving levosimendan had a markedly more severe baseline profile, including previous heart failure (72.7% vs 40.9%), preoperative inotropic support (27.3% vs 0%), preoperative oliguria (36.4% vs 4.5%), and a higher mean EuroSCORE II (7.01 ± 5.66 vs 3.83 ± 2.30). Within the levosimendan group, persistent oliguria decreased from 27.3% to 9.1%, and 36.4% of patients reached an LVEF > 50% at 48 hours. ICU length of stay was similar between groups (3.1 vs 2.64 days; p = 0.43). Reduction in inotropic support was less frequent in the levosimendan group (54.5% vs 93.9%; p = 0.009), while 30-day mortality was higher (45.5% vs 6.1%; p = 0.002).
Conclusion: In this non-randomized cohort with substantial baseline imbalance, levosimendan was preferentially used in the sickest patients and was associated with early favorable hemodynamic signals on diuresis and systolic function. However, no firm prognostic benefit can be inferred from this exploratory comparison. Prospective multicenter studies with severity adjustment are warranted.