Background: Levosimendan is a calcium-sensitizing ionodilator. However, the current level of clinical evidence is insufficient to determine the clinical value of levosimendan in patients with severe left ventricular dysfunction subjected to cardiac surgery. The aim of this meta-analysis to provide an update of the current clinical evidence regarding the clinical value of perioperative levosimendan use in adult patients with severe cardiac dysfunction subjected to cardiac surgery. Methods: This meta-analysis was performed according to PRISMA statement. Databases searched included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews. Search keywords were extracted from initially retrieved articles and comprised “levosimendan" and “cardiac surgery" using the Boolean search operator AND. The reported outcomes included early mortality, development of atrial fibrillation, acute kidney injury and/or renal replacement therapy, postoperative myocardial infarction, hypotension and low cardiac output syndrome. Aim of the work: The aim of this meta-analysis to provide an update of the current clinical evidence regarding the clinical value of perioperative levosimendan use in adult patients with severe cardiac dysfunction subjected to cardiac surgery. Results: The present meta-analysis showed significant association between levosimendan use and significant reduction of perioperative low cardiac output syndrome [OR (95% CI): 0.60 (0.44-0.82), p=0.001], renal injury and/or renal replacement therapy [OR (95% CI): 0.51 (0.30-0.86), p=0.01]. Also, levosimendan use was associated with a marginal trend towards lower mortality [OR (95% CI): 0.64 (0.39-1.03), p=0.07]. Conclusions: Levosimendan use is associated with reduction of perioperative low cardiac ou