<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-3347</journal-id>
<journal-title><![CDATA[Colombian Journal of Anestesiology]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. colomb. anestesiol.]]></abbrev-journal-title>
<issn>0120-3347</issn>
<publisher>
<publisher-name><![CDATA[SCARE-Sociedad Colombiana de Anestesiología y Reanimación]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-33472019000300142</article-id>
<article-id pub-id-type="doi">10.1097/cj9.0000000000000121</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Perioperative use of levosimendan in patients undergoing cardiac surgery: systematic review and meta-analysis]]></article-title>
<article-title xml:lang="es"><![CDATA[Uso perioperatorio de levosimendán en pacientes sometidos a cirugía cardiaca: revisión sistemática de la literatura y metaanálisis]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliveros]]></surname>
<given-names><![CDATA[Henry]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García]]></surname>
<given-names><![CDATA[Hans]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rubio]]></surname>
<given-names><![CDATA[Cristhian]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Navarrete]]></surname>
<given-names><![CDATA[Javier]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la Sabana  ]]></institution>
<addr-line><![CDATA[ Chía]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Militar Central  ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Militar Nueva Granada  ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2019</year>
</pub-date>
<volume>47</volume>
<numero>3</numero>
<fpage>142</fpage>
<lpage>153</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-33472019000300142&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-33472019000300142&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-33472019000300142&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Patients undergoing cardiac surgery frequently develop low cardiac output syndrome (LCOS). Multiple interventions including levosimendan have been used in the prevention and treatment of LCOS. Preliminary studies reported lower mortality respect to placebo or other inotropes, however, recently, 3 clinical trials found no benefit against this outcome.  Objective: Our objective was to evaluate the evidence of levosimendan on mortality and secondary outcomes in patients undergoing cardiac surgery, and to determine the sources of heterogeneity.  Methods: We conducted a systematic review and meta-analysis of the clinical trials that evaluated the efficacy of levosimendan in patients undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality and other outcomes such as kidney injury with dialysis requirement and LCOS, using fixed and random effects models. The risk of bias was assessed and the sources of heterogeneity were explored.  Results: Of 47 studies identified, 14 studies were selected (n=2752). Regarding the mortality outcome and use of levosimendan, only a decrease was found in the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While high-quality studies, there was no protective effect (OR 0.99,95% CI 0.70-1.40) with an I2 = 0%. The quality of the studies and ejection fraction were the main sources of heterogeneity.  Conclusion: In high-quality studies, the use of levosimendan in patients undergoing cardiovascular surgery has no effect on 30-day mortality. There was a protective effect on postoperative renal failure with dialysis.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoperatorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encontraron beneficio frente a este desenlace.  Objetivo: Evaluar la evidencia del levosimendán sobre la mortalidad y los desenlaces secundarios en pacientes sometidos a cirugía cardiaca, y determinar las fuentes de heterogeneidad.  Métodos: Mediante una revisión sistemática y metaanálisis de los experimentos clínicos que evaluaron la eficacia del levosimendán en los pacientes llevados a cirugía cardiaca, se evaluó la eficacia en la mortalidad y en otros desenlaces, como lesión renal y SBGC, utilizando los modelos de efectos fijos y aleatorios.  Resultados: De 47 estudios identificados, fueron seleccionados 14 (n = 2752). Respecto al desenlace de mortalidad y el uso de levosimendán solo se encontró una disminución en los estudios de baja calidad (OR 0.30; IC 95%, 0.18-0.51), mientras que para los de alta calidad no hubo efecto protector (OR 0.99; IC 95%, 0.70-1.40) con un I2=0%. La calidad de los estudios y la fracción de eyección fueron las principales fuentes de heterogeneidad.  Conclusión: el uso del levosimendán en los pacientes llevados a cirugía cardiovascular no tiene efectos sobre la mortalidad a 30 días en los estudios de alta calidad. Hubo efecto protector sobre la falla renal postoperatoria con necesidad de diálisis.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Meta-analysis]]></kwd>
<kwd lng="en"><![CDATA[Mortality]]></kwd>
<kwd lng="en"><![CDATA[Cardiac Output]]></kwd>
<kwd lng="en"><![CDATA[Low]]></kwd>
<kwd lng="en"><![CDATA[Acute Kidney Injury]]></kwd>
<kwd lng="en"><![CDATA[Dialysis]]></kwd>
<kwd lng="en"><![CDATA[Atrial fibrillation]]></kwd>
<kwd lng="es"><![CDATA[Metaanálisis]]></kwd>
<kwd lng="es"><![CDATA[mortalidad]]></kwd>
<kwd lng="es"><![CDATA[Gasto cardiaco bajo]]></kwd>
<kwd lng="es"><![CDATA[Lesión renal aguda]]></kwd>
<kwd lng="es"><![CDATA[Diálisis]]></kwd>
<kwd lng="es"><![CDATA[Fibrilación auricular posoperatoria]]></kwd>
</kwd-group>
</article-meta>
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