Levosimendan is a calcium-sensitizing agent that has been evaluated in adults with acute decompensatedheart failure and in patients with chronic heart failure (83, 84, 85 and 86). This agent binds to troponin-Cin cardiac myocytes and improves cardiac contractility. It also opens adenosine triphosphate (ATP)-sensitive potassium channels causing peripheral arterial and venous dilation. There is no increase inmyocardial oxygen consumption or arrhythmias. Although initial experience with levosimendan wasencouraging in both adults and children (87), results from a large prospective randomized trial failed toshow any benefit of levosimendan over dobutamine in 180-day mortality or any other secondary outcomes(88).
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