LEVOSIMENDAN NO MANEJO DA INSUFICIÊNCIA CARDÍACA EM CRIANÇAS: UMA ANÁLISE DE EFICÁCIA

Abstract

INTRODUCTION: Simendan is an inotropic agent used in the treatment of decompensated heart failure (HF), standing out for increasing myocardial contractility without significantly raising oxygen consumption. It also promotes vasodilation, reducing cardiac overload and improving tissue perfusion. Several studies investigate its safety and efficacy in children with cardiac dysfunction, especially in critical conditions. OBJECTIVE: To evaluate the effectiveness of Simendan in the treatment of heart failure in children. METHODS: This integrative review was conducted using the PubMed and Cochrane databases, with the descriptors “Simendan,” “Heart Failure,” “Treatment,” and “Children.” No filtering criteria were applied regarding the language or year of publication of the studies, allowing for the inclusion of a significant portion of the available literature. A total of 45 articles were initially identified, with 9 eliminated based on title analysis and 28 excluded after abstract review, including clinical trials and literature reviews. RESULTS: The findings indicated that Simendan improves cardiac function in children, significantly reducing end-systolic volume (p = 0.007) and heart rate (p = 0.009). Improvements were observed in systolic elastance (p = 0.008), arterial elastance (p = 0.038), ventricle-arterial coupling (p = 0.009), and mechanical efficiency of the heart (p = 0.008). The left ventricular ejection fraction showed a trend towards improvement (p = 0.054), as did the subaortic velocity-time integral (p = 0.041). In one study, 35% of patients experienced an increase in mean ejection fraction from 20% ± 12% to 35% ± 11% (p = 0.003). Repeated infusion allowed for the withdrawal of other inotropes and delayed the need for mechanical circulatory support. In terms of clinical outcomes, 89% of patients survived until ICU discharge, 78% were discharged from the hospital, 22% were referred for transplantation, and 89% were weaned off ventilatory support. Adverse effects included hypotension, tachycardia, and arrhythmias, which were generally mild and transient. CONCLUSION: Simendan is a promising therapeutic option for pediatric HF, reducing dependence on other inotropes, improving hemodynamic parameters, and increasing survival, with infrequent and mild side effects.