Early experience with Levosimendan in children with ventricular dysfunction

Objective. To describe our preliminary experience with Levosimendan, a new calcium-sensitizing agent in critically unwell infants and children with severe heart failure. Design. Retrospective cohort analysis. Setting. Pediatric intensive care unit. Patients: Fifteen children aged 7 days to 18 yrs (median age 38 months) with severe myocardial dysfunction secondary to end-stage heart failure, or acute heart failure, who were inotrope-dependent (requiring at least one catecholamine). Interventions. A single dose (bolus and intravenous infusion over 24-48 hrs) of Levosimendan was given under continuous hemodynamic monitoring in our intensive care unit. Eleven children received a single dose, three children received two doses, and one child received four doses. Echocardiographic assessments of ventricular function were made before and 3-5 days after Levosimendan infusion. Measurements and Main Results. Heart rate, systolic pressure, diastolic pressure, mean blood pressure, and central venous pressure were unchanged during and after Levosimendan. Levosimendan allowed for discontinuation of catecholamines in ten patients and a dose reduction in three. The dose of dobutamine was reduced from 6.4 mu g/kg/min pre-Levosimendan to 1.8 mu g/ kg/min on day 5 (p <.01). Ejection fraction for the group as a whole improved from 29.8% to 40.5% (p =.015); this did not increase significantly in patients with end-stage heart failure but increased by 63% in the children with acute heart failure. Conclusions. Levosimendan can be safely administered to infants and children with severe heart failure. Levosimendan allowed for substantial reduction in catecholamine infusions in children with end-stage or acute heart failure and also produced an objective improvement in myocardial performance in children with acute heart failure.