Levosimendan versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results from a Randomized Trial

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Thorlacius , E M , Wåhlander , H , Ojala , T , Ylänen , K , Keski-Nisula , J , Synnergren , M , Romlin , B S , Ricksten , S-E & Castellheim , A 2020 , ' Levosimendan versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results from a Randomized Trial ' , Journal of Cardiothoracic and Vascular Anesthesia , vol. 34 , no. 8 , pp. 2072-2080 . https://doi.org/10.1053/j.jvca.2020.02.027

Title: Levosimendan versus Milrinone for Inotropic Support in Pediatric Cardiac Surgery: Results from a Randomized Trial
Author: Thorlacius, Elin M.; Wåhlander, Håkan; Ojala, Tiina; Ylänen, Kaisa; Keski-Nisula, Juho; Synnergren, Mats; Romlin, Birgitta S.; Ricksten, Sven-Erik; Castellheim, Albert
Contributor organization: HUS Children and Adolescents
Children's Hospital
University of Helsinki
Helsinki University Hospital Area
Date: 2020-08
Language: eng
Number of pages: 9
Belongs to series: Journal of Cardiothoracic and Vascular Anesthesia
ISSN: 1053-0770
DOI: https://doi.org/10.1053/j.jvca.2020.02.027
URI: http://hdl.handle.net/10138/326956
Abstract: Objective : We aimed to determine the differential effects of intra-operative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was employed for myocardial function evaluation, utilizing biventricular longitudinal strain with two-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables. Design : A secondary analysis of a randomized, prospective, double-blinded clinical drug trial Setting : Two pediatric tertiary university hospitals Participants : Infants between 1-12 months of age diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass. Interventions : The patients were randomized to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours. Measurements and main results : Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning and prior to hospital discharge. The association between perioperative parameters and postoperative myocardial function was also investigated. Images were analyzed for left ventricular (n=67) and right ventricular (n=44) function. The day after surgery, left ventricular longitudinal strain was deteriorated in both the milrinone and levosimendan groups; 33% and 39%, respectively. The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (non-significant difference). For both groups, biventricular longitudinal strain approached their preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day one (p=0.014). Conclusions : Levosimendan was comparable to milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
Speckle tracking
Longitudinal strain
Congenital heart defect
Cardiopulmonary bypass
Randomized clinical trial
speckle tracking
cardiopulmonary bypass
randomized clinical trial
congenital heart defect
longitudinal strain
3123 Gynaecology and paediatrics
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: acceptedVersion

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