• Juan José Jiménez-Rivera, Andrea Álvarez-Castillo, Jorge Ferrer-Rodríguez, José Luis Iribarren-Sarrías, Martín Jesús García-González, Pablo Jorge-Pérez, Juan Lacalzada-Almeida, Rosalía Pérez-Hernández, Javier Montoto-López, and Rafael Martínez-Sanz.
• Department of Intensive Care, Hospital Universitario de Canarias, La Laguna Tenerife, S.C.Tenerife, Canary Islands, Spain. jjjimenezrivera@gmail.com.
• J Cardiothorac Surg. 2020 May 24; 15 (1): 108.

BackgroundPatients 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.MethodsIn 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.ResultsPreconditioning 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.ConclusionsPreconditioning 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.

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