Introduction .– Heart transplantation is the gold standard therapy for pediatric end-stage heart failure. Sometimes, the waiting time for a transplant may be long and a mechanical support is required despite the use of conventional inotropic drugs. Levosimendan was proved to be safe and efficient for the treatment of postoperative low cardiac output syndrome in children.

Aims .– To evaluate the effects of levosimendan in children who are waiting for heart transplantation.

Patients and methods.– In this single-center retrospective study, all the pediatric patients (under 18 years) in end-stage heart failure and with criteria for mechanical support, were included. All the patients were on the waiting list for heart transplantation. Each patient received at least one 24-hour infusion of levosimendan until either heart transplantation or mechanical support initiation. Clinical, biological and echocardiographic data were analyzed according to the infusions of levosimendan.

Results .– A total of six patients were included over a period of 24 months. The median age was 2 years (2 months–15 years). A total of 82 infusions were performed. Levosimendan had a positive effect on enteral feeding. The median BNP level decreased significantly between day 0 and day 2 (2443 ng/L [1458–3819] versus 1358 ng/L [1025–2534], P = 0.003). While only a trend was noted in the improvement of the left ventricular ejection fraction ( P = 0.054 by the Simpson’s method and P = 0.068 by the Teicholz method), the subaortic velocity time integral was significantly improved between day 0 and day 8 (12.8 cm/s [10–14.5] versus 15.3 cm/s [14.3–16.9], P = 0.041). Even if the efficacy of levosimendan seemed to progressively decrease over the time, the use of this drug allowed an average lifetime without mechanical support of 177 days. During this study, no adverse events have been reported, or attributed, to the use of levosimendan.

Conclusion.– Levosimendan improves hemodynamics in children in end-stage heart failure, allowing several months of life without mechanical support. This study argues for a systematic use of levosimendan, in addition to the usual inotropic drugs, in this context. Levels of BNP, quality of enteral feeding and echocardiographic parameters may help to determine the best timing for infusions.