Levosimendan is superior to dobutamine as an inodilator in the treatment of pulmonary hypertension for children undergoing cardiac surgery

Abstract

Purpose: To compare the effectiveness of levosimendan and dobutamine in reducing pulmonary artery pressure (PAP) and increasing cardiac output for children undergoing cardiac surgery.

Patients and methods: The study included 50 patients with high systolic pulmonary artery pressure (PAP) undergoing surgical repair of cardiac septal defects. Patients were randomly allocated to two equal groups: group L received levosimendan and group D received dobutamine. PAP was measured preoperatively, by use of transthoracic echocardiography (baseline), intraoperatively, directly, by use of a 22-gauge catheter inserted in the pulmonary artery, and postoperatively, by use of transesophageal echocardiography (TEE). Cardiac index (CI) was recorded by use of a transesophageal 4-MHz Doppler probe.

Results: Both drugs significantly reduced PAP compared with the level at the time of induction of anesthesia. Mean PAP measurement before chest closure, 1 and 20 h after ICU admission were significantly lower for patients who received levosimendan (32.7 ± 4.1, 25.8 ± 2.8, 19.8 ± 2 mmHg, respectively) than for those who received dobutamine (37.6 ± 2.75, 32.8 ± 2.36, 26.5 ± 2.2 mmHg, respectively). Both drugs significantly improved CI compared with its level at the time of induction of anesthesia. Mean CI measurements 5 min after weaning from cardiopulmonary bypass (CPB) until 20 h after ICU admission were significantly higher for patients who received levosimendan than for those who received dobutamine (3.55 ± 0.35, 3.8 ± 0.36, 3.81 ± 0.34, respectively, in group L vs. 3.4 ± 0.36, 3.6 ± 0.33, 3.66 ± 0.29, respectively, in group D).

Conclusion: Levosimendan is better than dobutamine for treatment of pulmonary hypertension of children undergoing cardiac surgery.