Perioperative use of levosimendan in complex congenital heart disease management.

UNLABELLED: This study evaluated the impact of perioperative levosimendan on in-hospital outcomes in children undergoing surgery for complex congenital heart disease. A retrospective cohort of 120 neonates and infants undergoing Norwood operation, arterial switch operation, or truncus arteriosus repair was analyzed. Median age at surgery was 29.5 days, and median weight was 4.0 kg. In-hospital mortality was higher in female patients, who exhibited a 2.64-fold greater mortality rate compared with males (33.3% vs. 12.6%). Levosimendan use was not significantly associated with a significant reduction in in-hospital mortality (aOR 0.76; 95% CI 0.07-1.46), major complications (aOR 0.87; 95% CI 0.44-1.30), or length of stay (aOR 0.76; 95% CI 0.36-1.16). However, treatment allocation was clinically based, introducing selection bias and confounding by indication, therefore still leaving the question of potential levosimendan efficacy in the CHD postoperative context unanswered. Thus, further studies are warranted.

CONCLUSION

In this retrospective cohort of high-risk pediatric patients undergoing complex congenital heart surgery, perioperative levosimendan was not associated with significant differences in in-hospital mortality, postoperative length of stay, or major complications.

WHAT IS KNOWN: • Vasoactive support is central after complex pediatric cardiac surgery; levosimendan is a calcium-sensitizer/inodilator used perioperatively. • Pediatric evidence is mixed: some reports suggest fewer LCOS events, but no consistent reduction in in-hospital mortality, AKI, ventilation duration, or LOS.

WHAT IS NEW: • In a national referral cohort from a middle-income country, perioperative levosimendan showed no significant difference in mortality, LOS, or major complications versus no levosimendan in complex congenital heart surgery (Norwood procedure, Arterial switch operation and  truncus arteriosus repair). • Among postoperative ECMO patients, LOS was numerically shorter with levosimendan but not statistically significant (exploratory).