Levosimendan: evolution over last two decades


  • Kishore Gupta Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India
  • Dhiren Shah Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India
  • Dhaval Naik Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India




Levosimendan, Heart failure, ECMO, LV dysfunction, Sepsis, Cardiorenal syndrome


Levosimendan was maiden agent at the time of its emergence, promoting inotropy mainly through calcium sensitization of cardiac troponin C (cTnC). Levosimendan seems a lucrative option but has not demonstrated a clear superiority to other inotropes in well-designed trials. We searched the PubMed database and reviewed the pertinent studies published till 2021 and summarized various trials/studies to come to a consensus regarding its indications in cardiac patients. Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent most widely accepted indication. Levosimendan infusions are increasingly used to facilitate extracorporeal membrane oxygenation (ECMO) weaning and avoiding hospitalizations in patients with end-stage heart failure. Levosimendan doesn’t seem to have long term survival benefit in ventricular dysfunction patients undergoing surgery. The evidence supporting the role in right ventricular failure is not well-established. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.

Author Biographies

Kishore Gupta, Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India

Consultant Cardiac Surgeon, 

Dept of cardiothoracic and vascular surgery,

CIMS hospital,Ahmedabad.

Dhiren Shah, Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India

Dept of cardiothoracic and vascular surgery,

CIMS hospital,Ahmedabad.

Dhaval Naik, Department of Cardiac Surgery, CIMS Hospital, Ahmedabad, Gujarat, India

Dept of cardiothoracic and vascular surgery,

CIMS hospital,Ahmedabad.


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