Authors:

T Ivanova-Razumova¹ , AI Baigalkanova¹ , U Ahash¹ , A Janatkyzy¹ , R Kaliev¹ , TM Alpysbaeva¹ , K Mahambetova¹ , ¹National research cardiac surgery center, pediatric cardiology - Astana - Kazakhstan ,

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..