Levosimendan in Cardiac Surgery

Abstract

To the Editor: Landoni et al. (May 25 issue)1 examined levosimendan administration versus placebo for patients requiring hemodynamic support after cardiac surgery. In their trial (Levosimendan to Reduce Mortality in High Risk Cardiac Surgery Patients: A Multicenter Randomized Controlled Trial [CHEETAH]), they found no significant difference in mortality between the two groups. The investigators aimed to include patients with shock after cardiac surgery and cardiopulmonary bypass. However, many of the patients were likely to have distributive shock (i.e., 57.7% received epinephrine, 45.3% norepinephrine, and 15.2% dopamine) rather than cardiogenic shock (28.3% received dobutamine and 12.5% enoximone) (Table S5 in the . . .