[Levosimendan, a new inotropic drug: experience in children with acute heart failure]

Area of Science:

• Pediatric Cardiology
• Cardiovascular Pharmacology
• Critical Care Medicine

Background:

• Low cardiac output syndrome (LCOS) is a frequent and serious complication following pediatric cardiac surgery.
• Current treatments, such as catecholamines, carry risks of adverse effects.
• Levosimendan (LEVO) is an inotropic agent that warrants investigation for LCOS management in children.

Purpose of the Study:

• To evaluate the efficacy of levosimendan (LEVO) in improving cardiac output in pediatric patients with post-surgical LCOS.
• To assess the safety profile of levosimendan (LEVO) in this vulnerable patient population.

Main Methods:

• An open, prospective, quasi-experimental cohort study was conducted.
• Levosimendan (LEVO) was administered as compassionate treatment for refractory post-surgical LCOS.
• Patients received a loading dose followed by a continuous infusion; clinical, echocardiographic, hemodynamic, and laboratory assessments were performed pre- and post-infusion.

Main Results:

• Levosimendan (LEVO) infusion was successful in 50% of the 18 interventions (in 14 children).
• Significant improvements were observed in mixed venous oxygen saturation (SvO2), while inotropic score and A-VDO(2)2 decreased.
• No adverse effects related to levosimendan (LEVO) administration were reported; four deaths occurred, unrelated to the drug.

Conclusions:

• Levosimendan (LEVO) demonstrated efficacy in improving cardiac output in pediatric patients with post-surgical LCOS.
• The study suggests levosimendan (LEVO) is a safe therapeutic option for this condition, with no observed adverse events.
• Further research may be warranted to optimize levosimendan (LEVO) use in pediatric cardiac critical care.