Aim To explore the effect of levosimendan on survival and prognosis of elderly patients undergoing coronary artery bypass grafting (CABG). Methods 84 elderly patients with coronary heart disease undergoing selective CABG were randomly divided into treatment group (44 cases) and control group (40 cases). 10 minutes before cardiopulmonary bypass, levosimendan was administered in treatment group for 24 hours, and equal amount of normal saline was administered instead of levosimendan in control group. Mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), mixed venous oxygen saturation (SvO2), systemic vascular resistance index (SVRI) and cardiac index (CI) were monitored. The postoperative incidence of low cardiac output syndrome (LCOS), intensive care unit (ICU) stay time, ventilator assist time, intra-aortic balloon pump usage and norepinephrine usage were compared between the two groups. Postoperative follow-up of 180 days, the event-free survival rate was compared between the two groups. Results The levels of CI and MAP in the treatment group at 2 and 24 hours after operation were significantly higher than those in the control group (P＜0.05), while the levels of SVRI and PCWP in the treatment group were significantly lower than those in the control group (P＜0.05). The postoperative incidence of LCOS, ICU stay time, ventilator assist time and norepinephrine use rate in the treatment group were significantly lower than those in the control group (P＜0.05). The 180-days event-free survival rate was 88.5% in the treatment group and 67.1% in the control group, and Log-rank test showed that there was a significant difference in the event-free survival rate between the two groups (P＜0.05). Conclusion Levosimendan can improve the postoperative hemodynamic indexes of elderly CABG patients, prevent and treat LCOS, increase the event-free survival rate after operation, and improve the clinical prognosis of patients.