Role of Levosimendan in Post-operative Low Cardiac Output Management in Children
Shiraslan Bakhshaliyev1,2
, Ergin Arslanoğlu3, Bahruz Aliyev4, Fatih Yiğit5
1Department of Pediatric Cardiovascular Surgery, Liv Bona Dea Hospital, Baku, Azerbaijan
2Department of Pediatric Cardiovascular Surgery, Atlas University Hospital, Istanbul, Türkiye
3Department of Pediatric Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
4Department of Pediatric Cardiology, Liv Bona Dea Hospital, Baku, Azerbaijan
5Department of Cardiovascular Surgery, University of Health Sciences, Koşuyolu High Specialty and Research Hospital, İstanbul, Türkiye
Keywords: Ejection fraction; inotropic agents; levosimendan; low cardiac output syndrome; pediatric cardiac surgery.
Abstract
Objectives: Low cardiac output syndrome (LCOS) is a critical complication following pediatric cardiac surgery that is characterized by myocardial dysfunction, hemodynamic instability, and insufficient organ perfusion. Levosimendan, an inotropic agent that enhances calcium sensitivity in cardiac muscle and causes vasodilation, has been proposed as a therapeutic option for managing LCOS in children. This study aimed to evaluate the efficacy and safety of levosimendan in the 23 management of LCOS in pediatric patients following cardiac surgery.
Methods: This study retrospectively included patients who underwent surgery in our clinic between 2020 and 2023 and received levosimendan due to post-operative LCOS. The patients’ medical records were accessed through the hospital information system and archival review.
Results: The median age of the patients was 8 months (interquartile range: 5.0–16.0 months). Post-operative echocardiographic assessments revealed a significant improvement in ejection fraction, with a median increase from 40.0% to 57.5% in survivors (p<0.001). No significant difference in mortality, intensive care unit stay, or hospital stay was observed between survivors and non-survivors, although non-survivors had a higher post-operative heart rate (p=0.025). Levosimendan was well tolerated, with minimal adverse effects, and no arrhythmias were recorded. Hypotension was effectively managed with norepinephrine.
Conclusion: Levosimendan appears to be an effective and safe treatment option for managing LCOS in pediatric patients after cardiac surgery. While the drug significantly improved cardiac function, further large-scale studies are necessary to evaluate its long-term efficacy and safety. Individualized dosing and careful monitoring are essential to optimize patient outcomes.
Cite This Article: Bakhshaliyev S, Arslanoğlu E, Aliyev B, Yiğit F. Role of Levosimendan in Post-operative Low Cardiac Output Management in Children. Koşuyolu Heart J 2025;28(3):119–124