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Levosemindan using in pediatric patients with end-stage heart failure: single center experience.
Authors : T Ivanova-Razumova (Astana,KZ), AI Baigalkanova (Astana,KZ), U Ahash (Astana,KZ), A Janatkyzy (Astana,KZ), R Kaliev (Astana,KZ), TM Alpysbaeva (Astana,KZ), K Mahambetova (Astana,KZ)
T Ivanova-Razumova1
,
AI Baigalkanova1
,
U Ahash1
,
A Janatkyzy1
,
R Kaliev1
,
TM Alpysbaeva1
,
K Mahambetova1
,
1National research cardiac surgery center, pediatric cardiology - Astana - Kazakhstan
,
Topic(s): Chronic Heart Failure – Treatment
Background: in adult patients with end-stage heart failure repetitive levosimendan infusions are widely used. In this population multiple infusions of levosimendan leads to improvement of hemodynamics and relief of symptoms, and also decrease rehospitalization rates. But data’s about repeated levosimendan infusions effects in children and infants with decompensated heart failure are limited.
Purpose: to evaluate effectiveness and safety of multiple levosimendan infusions in pediatric patients with end stage heart failure.
Methods: from January 2015 up to December 2018 65 children’s with end-stage heart failure were under observation in our center. Median age – 5,4 years (range 2 month – 15 years). Boys 28 (43%), girls – 37 (57%). For all patients standard clinical investigations, ECHO, pro-BNP levels, 6-MWT (in patients older 6 year) were performed at baseline before first administration of levosemindan and 3 days after, and then in the same schedule during next hospitalisations. We have done 2-3 levosimendan administrations during one hospitalization with 7-10 days interval. Median period between rehospitalisations was 3 month. Total number of infusions was – 358. The continuous infusion of levosimendan was uptitrated to a maximum dose of 0.2 mg/kg/min in all patients, first 24 hours – we have administrate drug in dose 0,1 mg/ kg/min, next 24 hours – 0,2 mg/kg/day.
Results: Total number of infusions for 65 patients during 3 year composed 358. In 16 patients (24%) with hypotension we have used combination of levosimendan and dobutamin. ECHO data’s: mean left ventricle ejection fraction (LVEF) before and after first levosimendan administration was not significantly changed – 18 ± 5% vs 20 ± 6,3% respectively. However, during follow-up period after 5-6 infusions mean LVEF significantly increased 25 ± 3,8 % (p<0.005). Baseline mean pro-BNP level was – 22000 ± 7567 pg/ml, after the first two infusions it was significantly decrease – 15000 ± 5500 pg/ml (p<0.005). During follow-up period continued decreasing of pro-BNP level has been noted. Mean pro-BNP level after 6 infusions was 7500 ± 1853 pg/ml, significantly lower in comparison with baseline (p= 0.03). There were no serious adverse events in the study population.
Conclusions: our data shows that multiple levosimendan infusions in children with end-stage heart failure demonstrate positive clinical and hemodynamic effects, well tolerated without severe adverse events. Further evaluation is required for determine optimal levosimendan administration regimen, frequency and combination with other inotropic drugs in children’s with severe heart failure..
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.