title: Successful use of levosimendan as a primary inotrope in pediatric cardiac surgery: An observational study in 110 patients.
abstract: BACKGROUND
  Levosimendan is a new generation inotrope with calcium sensitizing properties and proven benefits in adults.
  
  
  OBJECTIVE
  This study investigates the use of levosimendan as a first line inotrope in congenital heart surgery.
  
  
  METHODS
  Prospective, observational study in a tertiary care center.
  
  
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Reena Khantwal
authors.initials: RK
authors.lastname: Joshi
authors.affiliation: Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Aggarwal
authors.affiliation: Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Mridul
authors.initials: M
authors.lastname: Aggarwal
authors.affiliation: Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Pandey
authors.affiliation: Department of Research, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Veronique
authors.initials: V
authors.lastname: Dinand
authors.affiliation: Department of Pediatric Cardiac Sciences, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Joshi
keywords: Levosimendan; low cardiac output; pediatrics cardiac surgery