Levosimendan Versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results From a Randomized Trial

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Pediatric cardiac surgery requires careful management of myocardial function.
• Inotropic agents like milrinone and levosimendan are used to support cardiac function during and after surgery.

Purpose of the Study:

• To compare the effects of intraoperative milrinone versus levosimendan on myocardial function in pediatric patients undergoing cardiac surgery.
• To evaluate biventricular longitudinal strain and conventional echocardiographic variables to assess myocardial function.

Main Methods:

• Secondary analysis of a randomized, prospective, double-blinded clinical trial.
• Inclusion of infants (1-12 months) with specific congenital heart defects undergoing corrective surgery.
• Randomized assignment to milrinone or levosimendan infusion during cardiopulmonary bypass for 26 hours.

Main Results:

• No significant difference in the deterioration of left or right ventricular longitudinal strain between milrinone and levosimendan groups on postoperative day 1.
• Biventricular longitudinal strain returned to near preoperative levels by hospital discharge in both groups.
• Preoperative N-terminal pro-brain natriuretic peptide levels predicted postoperative day 1 left ventricular strain.

Conclusions:

• Levosimendan and milrinone demonstrated comparable efficacy for inotropic support of left and right ventricular function in pediatric cardiac surgery.
• Both agents facilitated recovery of myocardial function by hospital discharge.