Reena Khantwal Joshi1, Neeraj Aggarwal1, Mridul Aggarwal1, Rakesh Pandey1, Veronique Dinand2, Raja Joshi1
1 Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Research, Sir Ganga Ram Hospital, New Delhi, India
Context: Levosimendan is a new generation inotrope with calcium sensitizing properties and proven benefits in adults.
Aims: This study investigates the use of levosimendan as a first line inotrope in congenital heart surgery.
Settings and Design: Prospective, observational study in a tertiary care center.
Materials and Methods: One hundred and ten patients undergoing congenital cardiac surgery received levosimendan at a loading dose of 12 mcg/kg during rewarming on cardiopulmonary bypass followed by continuous infusion of 0.1 mcg/kg/min for 48 h. Hemodynamic parameters were recorded at the time of admission to Intensive Care Unit, and at 3 h, 6 h, 12 h, 24 h, and 48 h thereafter.
Statistical Analysis: Categorical variables were compared using Chi-square test. Non-normally distributed quantitative variables were compared between groups using Kruskal-Wallis test.
Results: At discharge from operating room (OR), 36 (32.7%) patients required levosimendan alone to maintain optimum cardiac output, 59 (53.6%) patients required the addition of low-dose adrenaline (<0.1 mcg/kg/min) and 15 (13.6%) patients required either increment in adrenaline to high-dose (≥0.1 mcg/kg/min) or starting another inotrope/vasoactive agent. Overall, there were five mortalities. Hypotension leading to discontinuation of levosimendan was not found in any patient. Arrhythmias were observed in three patients. Fifty-four patients were extubated in the OR.
Conclusions: Levosimendan-based inotropic regime offers optimized cardiac output with a well-controlled heart rate and a low incidence of arrhythmias in patients undergoing all categories of congenital heart surgeries.
Reena Khantwal Joshi
Department of Pediatric Cardiac Sciences, Institute of Child Health and Dharamvira Heart Center, Sir Ganga Ram Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
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