Levosimendan in Children with Heart Failure and Post-Surgical Palliation: Current Evidence on Efficacy and Safety"

Abstract

Introduction: Pediatric heart failure presents unique therapeutic challenges, especially in refractory cases or those with single ventricle physiology. This narrative review explores the use of levosimendan as a promising inotropic alternative, highlighting its efficacy even in patients on beta-blockers. Evidence suggests improvement in myocardial contractility, ventricle-arterial coupling, and clinical tolerance, reinforcing its potential in complex scenarios.Objectives: The study aims to provide a foundation for more effective and safer practices in pediatric cardiology.Methods: This narrative review analyzed five studies published between 2008 and 2025 on the use of levosimendan in children with heart failure. The search was conducted in renowned databases, with strict inclusion criteria. The selected studies addressed the efficacy and safety of the drug in contexts such as single ventricle physiology, postoperative settings, and refractory cases, focusing on relevant clinical parameters.Results and Discussion: The review examined the use of levosimendan in pediatric heart failure, highlighting hemodynamic benefits in single ventricle physiology and postoperative scenarios, with a good safety profile. Studies showed improvement in ventricle-arterial coupling and control of low cardiac output, though there was no significant impact on mortality or length of hospitalization. Compared to milrinone, levosimendan showed similar performance but with higher risk in patients with severe renal dysfunction. The findings suggest promising efficacy but emphasize the need for more robust studies.Conclusion: Levosimendan shows potential benefit in controlling pediatric low cardiac output, but its effects on critical outcomes are still limited, requiring individualized approaches and further robust studies to guide its safe clinical use.