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

Abstract

To compare the effectiveness of levosimendan and dobutamine in reducing pulmonary artery pressure (PAP) and increasing cardiac output for children undergoing cardiac surgery. 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. Both drugs significantly reduced PAP compared with the level at the time of induction of anesthesia. Mean PAP measurement before chest closure, 1 and 20h after ICU admission were significantly lower for patients who received levosimendan (32.7±4.1, 25.8±2.8, 19.8±2mmHg, respectively) than for those who received dobutamine (37.6±2.75, 32.8±2.36, 26.5±2.2mmHg, respectively). Both drugs significantly improved CI compared with its level at the time of induction of anesthesia. Mean CI measurements 5min after weaning from cardiopulmonary bypass (CPB) until 20h 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). Levosimendan is better than dobutamine for treatment of pulmonary hypertension of children undergoing cardiac surgery.