Levosimendan reverses right-heart failure in a 51-year-old patient after heart transplantation
o m E RIMARY GRAFT FAILURE in the early postoperative period after heart transplantation is a severe complicaion, potentially leading to multiorgan failure, presenting ith a poor outcome. It seems to be the result of poor donor onditions, acute cellular and humoral rejection, and proonged ischemia time.1 Therapeutic options are limited to harmacologic support with catecholamines and phosphodisterase inhibitors. Mechanical support with intra-aortic ounterpulsation or extracorporeal membrane oxygenation ECMO) may be necessary in severe cases of primary graft ailure.1,2 Levosimendan (Simdax; Abbott GesmbH, Vienna, Austria) s a Ca2 -sensitizer with a positive inotropic effect that acts ithout increasing the myocardial oxygen consumption. Its eneficial effects have already been described in patients with cute heart failure as well as in patients with low-output synrome after cardiac surgery.3,4 A potential benefit in patients ith right-heart failure has also been proposed.5-7 Levosimendan might be an additional therapeutic approach n this clinical scenario. Its use has been described in heartransplanted patients refractory to pharmacologic support obiating mechanical support.8 The present case shows successful nd rapid weaning from ECMO in a patient with acute primary raft failure after heart transplantation.