Levosimendan Versus Dobutamine in Children with Acute Heart Failure

Heart failure in children causes substantial morbidity and mortality, so we need an inotropic agent like levosimendan that improves the hemodynamics and relief of symptoms without adverse effects on survival. The aim of this study is to assess the effect of levosimendan vs. dobutamine in children with heart failure. Fifty patients with heart failure caused on by dilated cardiomyopathy, severe critical aortic stenosis, or coarctation of aorta (COA), as well as those who experienced heart failure after cardiac surgery were considered for this study. Patients received either levosimendan or dobutamine infusion for 4-5 days, after they were split into two equal groups. After three months of treatment, the effectiveness of the treatment is evaluated based on changes in the patients' left ventricular (LV) function, heart rate, blood pressure, pulmonary artery (PA) pressure, degree of mitral valve regurgitation, and need for re-hospitalization. The ejection fraction, heart rate, and systolic blood pressure improved in the patients who received the levosimendan and more in those with congenital heart disease of those post-cardiac surgery heart failure. The pulmonary artery pressure and degree of mitral valve regurgitation decreased significantly when levosimendan was used (from 50.92 to 30.38 mmHg and from 80% to 24%, respectively). The period of follow-up for patients of both treatments extended for three months, 15 patients needed another admission in patients on dobutamine infusion, and only 2 patients using levosimendan infusion had needed another admission, no patients developed arrhythmia from those on levosimendan but 6 patients developed arrhythmia in dobutamine group. It was concluded that Levosimendan is an effective drug in improving the survival of children with heart failure, delaying need of extracorporeal membrane oxygenation (ECMO), cardiac transplantation, and decreasing the hospitalization.