Early experience with levosimendan in children with low-output syndrome after cardiac surgery

Introduction

After cardiac surgery, most children require inotropic support. Dobutamine, dopamine and milrinone are not always effective, however, and in some cases these drugs are associated with significant adverse effects. Levosimendan, a new calcium-sensitizing agent, may be an alternative to treatment of this syndrome, with positive inotropic effects, vasodilating properties without cathecolamine release. We sought to investigate the effect of levosimendan in children after cardiac surgery.

Methods

A prospective open-label study was carried out in 18 children. Their mean age was 42 months (5 days–18 years), the mean ejection fraction was 31% and all of them required one or more inotropic drug for more than 24 hours before receiving levosimendan. Levosimendan was administered without bolus dose, in an intravenous infusion of 0.2 μg/kg/min over 24 hours. Echocardiographic assessments of ventricular function were made before and 3–5 days after levosimendan infusion.

Results

The heart rate, systolic pressure, diastolic pressure, mean blood pressure, and central venous pressure were unchanged during and after levosimendan administration. Levosimendan allowed for discontinuation of catecholamines in 10 patients and a dose reduction in five patients. The dose of dobutamine was reduced from 8.4 μg/kg/min prelevosimendan to 3 μg/kg/min on day 5 (P < 0.01). The ejection fraction for the group improved from 31% to 40.5% (P < 0.01).

Conclusion

Levosimendan can be safely administered to infants and children with low-output syndrome after cardiac surgery. Levosimendan allowed for significant reduction in catecholamine infusions and also produced an objective improvement in myocardial performance in children after cardiac surgery without significant adverse effects.