Levosimendan versus milrinone for pediatric cardiac surgery

BACKGROUND: Our aim is to check effectiveness of intravenous Levosimendan in comparison with intravenous Milrinone in congenital heart surgery with cardiopulmonary bypass. MATERIALS AND METHODS: 50 Paediatric patients between 2 months to 12 years of age divided into two groups. Group L (n=25) received inj. levosimendan 12μg/kg over 10 minutes1 after cross clamp removal and 0.1μg/kg/min started after that. Group M (n=25) received inj. milrinone 50μg/kg of bolus dose over period of 10 minutes and 0.5 μg/kg/min infusion thereafter. Both the group received inj. dopamine 5-8 μg/kg/min from beginning. Inj. noradrenalin 0.1μg/kg/min added as rescue drug for persistent hypotension. The drugs compared for hemodynamic (including echocardiography parameters), respiratory parameters (including ABG), fluid requirements, urine output, temperature monitoring and also for routine laboratory investigations (including platelet count) postoperatively. Time taken for extubation after shifting the patient was also observed. Both the groups were compared for side effects and need of additional ionotropic support, anti-arrhythmic drug or other medication-intervention requirements. RESULTS: Milrinone has more effect on vascular resistance. PVR reduced more in comparison with levosimendan with improved RV function. Milrinone has good effect on RV function. Milrinone had more hypotensive episodes and incidence of renal dysfunction than levosimendan. Levosimendan has more effect on LV contractility and better effect on PCWP. Levosimendan maintains hemodynamics better than milrinone. CONCLUSION: Levosimendan has better hemodynamic profile and lesser complication rate than milrinone.