Comparison of Hemodynamic Effects of Milrinone, Levosimendan, and Dobutamine in Bidirectional Cavopulmonary...

AimThe present study was done to compare the hemodynamic effects of 3 drugs-milrinone, levosimendan, and dobutamine in patients undergoing bidirectional cavopulmonary connection (BCPC) surgery.Materials and MethodsIn this prospective observational study, a total of 75 patients between 3 months and 2 years of age who underwent BCPC were included. They were divided into milrinone (M), levosimendan (L), and dobutamine (D) groups. The primary aim was to compare the hemodynamic effects of 3 drugs in this subset of patients.ResultsThe mean age at surgery was 6.4 ± 2.6 months, with no significant differences in gender or weight among the groups. Perioperatively, heart rate and femoral venous pressure were significantly higher in the dobutamine group. Significant differences were noted in SpO₂, Glenn pressures, Glenn pressure to mean arterial pressure (MAP) ratios, and near infrared spectroscopy values, with milrinone showing the most favorable outcomes, followed by levosimendan and dobutamine. Postoperative E/e' values were significantly lower in all groups (P < .001), with milrinone (4.7 ± 0.5) performing better than levosimendan (4.9 ± 0.9) and dobutamine (6.5 ± 1.2). Vasoactive inotropic scores decreased postoperatively in all groups but were significantly higher in the levosimendan group. No significant differences were observed in the duration of mechanical ventilation or intensive care unit stay. Notably, there were no mortalities during the study period.ConclusionsMilrinone offers superior hemodynamic benefits over levosimendan and dobutamine in patients undergoing BCPC using cardiopulmonary bypass. Its ability to significantly reduce Glenn pressure, lower the Glenn pressure to MAP ratio, and improve both systolic and diastolic functions makes it the preferred inotropic agent in this subset of patients.