Abstract
Background: Levosimendan is a calcium-sensitizing inotrope with vasodilatory properties, shown to improve cardiac output and reduce mortality in adults with advanced heart failure. However, data on its safety and efficacy in neonatal cardiac surgery are limited. Objective: To evaluate the intraoperative use of levosimendan in neonates with complex congenital heart defects (CHDs) undergoing open-heart surgery. Methods: We conducted a retrospective observational study of 59 neonates aged 2-30 days who underwent surgical correction of complex CHDs with cardiopulmonary bypass. Levosimendan was administered intracoronarily as part of the blood cardioplegia protocol in doses of 25-45 mcg/kg. Results: Compared to historical controls, the levosimendan group demonstrated a significant reduction in postoperative catecholamine requirements, including adrenaline and norepinephrine. In 12% of cases, surgery was completed without the use of any catecholamines. No rhythm disturbances were observed. The positive inotropic effect lasted up to 72 h without systemic hypotension. Median adrenaline doses were significantly lower (p < 0.05), and norepinephrine use was reduced from 12% to 5%. Conclusions: Intracoronary administration of levosimendan during neonatal cardiac surgery appears to reduce catecholamine dependence and support myocardial recovery without causing rhythm disturbances or hypotension. Further randomized controlled trials are needed to validate these findings.