Optimization of levosimendan before left ventricular assist device implantation in pediatric patients.

OBJECTIVE

The pediatric patient group undergoing left ventricular assist device (LVAD) implantation is small and unique. Many efforts have been made to prolong survival. In our study, we aimed to evaluate the effects of levosimendan administration on postoperative outcomes in pediatric patients undergoing LVAD implantation.

METHODS

This retrospective single-center study included patients under 18 years of age who underwent LVAD implantation. Patients with INTERMACS class 1 were excluded from the study. Patients were divided into two groups: Group A (n = 14), who received levosimendan preoperatively in addition to standard inotropic therapy, and Group B (n = 17), who received standard inotropic therapy alone. Levosimendan was administered at a dose of 0.1 µg/kg/min for 72 h without a loading bolus. Primary outcomes were early right ventricular failure and in-hospital mortality. Secondary outcomes included the need for right ventricular assist, late right ventricular failure, and changes in organ function as assessed by liver and kidney function tests. Safety points for drug administration were defined as arrhythmia, hypotension, and sudden arrest.

RESULTS

Baseline characteristics (except LVEDD), ventricular function, and vasoactive inotropic scores were similar between the groups. No significant difference was observed in terms of early right ventricular failure, in-hospital mortality, or length of hospital stay. The rates of need for right ventricular assist and late right ventricular failure were comparable. Improvements in organ function were observed in both groups; significantly greater reductions in aspartate aminotransferase and alanine aminotransferase levels were recorded in the levosimendan group. No treatment-limiting side effects were observed.

CONCLUSION

Preoperative levosimendan administration seems to be safe in pediatric LVAD candidates and is associated with improved end-organ function, although it has not demonstrated superiority over standard inotropic therapy in terms of preventing right ventricular failure or reducing mortality.