Objective To determine the clinical efficacy and safety of levosimendan for the very elderly patients with left heart failure. Methods A total of 58 very elderly patients [age: (86.8±1.5) years, 21 males and 37 females] with chronic left heart failure admitted in our department from September 2014 to April 2015 were prospectively recruited in this study. A self-controlled trial was carried out on the efficacy of levosimendan. Serum B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and 6-minute walking test (6MWT) were measured before and in 3 d and 3 months after treatment. Results In 3d after levosimendan treatment, their serum levels of BNP was significantly decreased, and the values of LVEF, LVFS and 6MWT were much better than before treatment (all P＜0.01). After 3 months’ treatment, the BNP level was obviously lower, and the values of LVEF, LVFS and 6MWT were greatly improved than those before treatment (all P＜0.01). There was no significant difference in blood pressure values, liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-transglutaminase (γ-GT)], and renal function indices [serum creatinine (SCr), blood urea nitrogen (BUN), and serum uric acid (SUA)] in the cohort before and in 3d and 3 months after treatment (P＞0.05). Conclusion Single dose levosimendan is efficient and safe in the treatment of heart failure for the very elderly.