Key result
Levosimendan is linked to improved ventriculo-arterial coupling and mechanical efficiency in single-ventricle infants with HF.
Why the study?
Levosimendan use has been described for paediatric low cardiac output after congenital heart surgery, but its effects on ventriculo-arterial coupling and ventricular energetic parameters after Norwood or hybrid palliation required evaluation.
Does levosimendan improve ventriculo-arterial coupling and cardiac efficiency in infants with single-ventricle physiology and cardiac failure after surgical palliation?
Observational (n=9)
No
Does levosimendan improve ventriculo-arterial coupling and cardiac efficiency in infants with single-ventricle physiology and cardiac failure after surgical palliation?
Effect estimate: Median difference -0.86 (95% CI -1.5 to -0.16)
p-value: p=0.009
In infants with single-ventricle physiology and heart failure after surgical palliation, levosimendan improved contractility, ventriculo-arterial coupling, and cardiac mechanical efficiency.
May improve VAC in single-ventricle infants with failure; hypothesis-generating case report requiring prospective validation.
OBJECTIVES: The use of levosimendan for paediatric patients with low cardiac output after congenital heart surgery has been recently described. We sought to evaluate ventriculo-arterial coupling (VAC) and other ventricular energetic parameters before and after 72 h from levosimendan start in infants with single-ventricle physiology and cardiac failure after palliation with Norwood or hybrid procedures. METHODS: In this single-centre retrospective study, 9 consecutive patients affected by hypoplastic left heart syndrome-like anatomy were retrospectively analysed. Systolic elastance, diastolic elastance, arterial elastance, VAC and cardiac mechanical efficiency were calculated by measuring, through 2-dimensional echocardiography, end-systolic volume and end-diastolic volume and by recording mean arterial pressure and central venous pressure. RESULTS: The median (range) weight and age were 2.8 (2.3-6) kg and 16.5 (6-116) days, respectively. After 72 h from levosimendan start, end-systolic volume significantly decreased (-1 ml, -3.2 to -0.1, P = 0.007), whereas mean arterial pressure and end-diastolic volume remained stable. Heart rate showed a significant decrease (-28 beats/min, -41 to 22, P = 0.008). Systolic elastance (2.9 mmHg/ml, 0.4-5.4, P = 0.008), arterial elastance (-5.9, -24 to -0.5, P = 0.038), VAC (-0.86, -1.5 to -0.16, P = 0.009) and cardiac mechanical efficiency (0.18, 0.03-0.22, P = 0.008) differences also showed significant modifications. CONCLUSIONS: In a small case series of patients with single-ventricle physiology, levosimendan showed to improve contractility and optimize VAC, with a reduction of heart rate. Monitoring of VAC and ventricular energetics can be an interesting aspect to improve the management of heart failure in infants with univentricular anatomy.
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Iacobelli et al. (2019) conducted an observational in Single-ventricle physiology and cardiac failure after surgical palliation (n=9). Levosimendan vs. Baseline (before levosimendan) was evaluated on Ventriculo-arterial coupling (VAC) (Median difference -0.86, 95% CI -1.5 to -0.16, p=0.009). Levosimendan significantly improved ventriculo-arterial coupling (median difference -0.86; P=0.009) and cardiac mechanical efficiency in infants with single-ventricle physiology and heart failure.
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