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Cardiovascular Disease |

Experience With Levosimendan as an Alternative to Catecholamines in Children

Fahad Alsohime, MD
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King Saud University, Riyadh, Saudi Arabia


Chest. 2015;148(4_MeetingAbstracts):67A. doi:10.1378/chest.2220367
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Abstract

SESSION TITLE: Cardiovascular Disease Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The objective of this study was to report experience with levosimendan in hemodynamically compromised children.

METHODS: all patients aged < 18years with severe myocardial dysfunction and dependent on inotrope support, who received levosimendan infusion, were reviewed for clinical, biological and echocardiographic (LV diameters, shortening fraction, sub-aortic Velocity Time Integral) data. Levosimendan was administered as a continuous intravenous infusion over 24 hours, starting 0.1 micrograms per kg per mn and increased up to 0.2micrograms per kg per mn. Blood pressure and heart rate were continuously monitored, ECG and Echocardiography recorded before, 3 and 5 days after starting levosimendan.

RESULTS: From 2007 to 2011, 8 patients aged 3.5 months to 13years (mean 41months) received 10 courses of levosimendan. All were on milrinone support (mean dose 0.63 mcg/kg/mn) and 3 on associated dobutamine. All achieved the 24-hour course of levosimendan without any complication. Catecholamines were successfully discontinued in 5 cases (3 weaned off at 24th hour and 2 at 5th day). Average milrinone dose dropped to 0.3 mcg/kg/mn at day-5, p=0.028). mean shortening fraction increased from 10.8%±1.8 before to 12.7± 2.3 at day-3 (p= 0.67), mean Velocity Time Integral from 6±0.6 to 8.7±1.2 cm at day-3 (p= 0.04). Five patients (62.5%) were successfully discharged from CICU: 2 are doing well at 1 and 4.5 years follow-up, 1 died from metabolic disease and 2 were readmitted at 1.5 - and 2-month interval and received a second course of levosimendan. The latter 2 patients did not improve and needed mechanical ventricular assistance (1 died and 1 underwent successful heart transplantation). For the remaining 3 patients, first course levosimendan failed and heart transplantation was performed in an emergency setting (pretransplant mechanical ventricular support in 2).

CONCLUSIONS: This small size sample study shows encouraging results of levosimendan in children with uncontrolled myocardial dysfunction. Further studies are needed to assess monitoring, timing and indications for repeated dose infusion during follow-up.

CLINICAL IMPLICATIONS: The role of Levosimendant in treating patients who are inotropes dependents should be widely investigated

DISCLOSURE: The following authors have nothing to disclose: Fahad Alsohime

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