Role of Levosimendan in Post-operative Low Cardiac Output Management in Children

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.