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First experiences with intraoperative Levosimendan in pediatric cardiac surgery
Wilhelm Alexander Osthaus1, Dietmar Boethig, Michael Winterhalter
1Klinik für Anästhesiologie und Intensivmedizin, OE 8050, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Osthaus.Alexander@MH-Hannover.de
Insights
Levosimendan, a calcium-sensitizing agent, shows promise in pediatric cardiac surgery. This study found it well-tolerated and beneficial for infants with severe myocardial dysfunction post-surgery.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Levosimendan is a calcium-sensitizing agent with proven efficacy in adult heart failure.
- Its use in pediatric cardiac surgery remains unexplored.
Purpose of the Study:
- To investigate the intraoperative application and effects of Levosimendan in infants undergoing complex congenital heart surgery.
- To assess the safety and efficacy of Levosimendan as a rescue therapy in this population.
Main Methods:
- Retrospective analysis of seven infants (2.6-6.3 kg) receiving intraoperative Levosimendan for severe myocardial dysfunction.
- Monitoring of heart rate, mean arterial blood pressure, central venous pressure, arterial lactate, and central venous oxygen saturation.
Main Results:
- Levosimendan administration did not alter heart rate, mean arterial blood pressure, or central venous pressure.
- Significant decreases in mean arterial lactate levels were observed at 24 and 48 hours post-infusion.
- Significant increases in central venous oxygen saturation were noted at 24 and 48 hours post-infusion.
Conclusions:
- Intraoperatively administered Levosimendan was well-tolerated in infants with severe myocardial dysfunction after complex congenital heart surgery.
- Levosimendan demonstrates beneficial effects and can be considered a valuable rescue drug in pediatric cardiac surgery.
Abstract:
Levosimendan is a calcium-sensitizing agent with effective inotropic properties. It has been shown to improve cardiac function, hemodynamic performance, and survival in adults with severe heart failure. However, the effect of Levosimendan in pediatric cardiac surgery has not yet been investigated. Thus, we report on our experience with the intraoperative application of Levosimendan in seven infants (body weight range 2.6-6.3 kg) with severe myocardial dysfunction after complex congenital heart surgery. During the administration of Levosimendan, the heart rate, mean arterial blood pressure, and central venous pressure did not change. The mean arterial lactate level significantly decreased 24 and 48 h after the first infusion compared to baseline. Central venous oxygen saturation increased significantly 24 and 48 h after the onset of Levosimendan infusion. We found intraoperatively administered Levosimendan to be well tolerated in the seven infants with severe myocardial dysfunction after complex congenital heart surgery. Levosimendan is a new rescue drug which has beneficial effects, even in pediatric cardiac surgery.
