Hemodynamic changes during off-pump coronary artery bypass anastomosis in patients with coexisting mitral regurgitation: improvement with milrinone.
We hypothesized that mitral regurgitation (MR) would be exacerbated, cardiac index (CI) decreased, and mean pulmonary artery pressure (MPAP) increased in patients with coexisting MR during off-pump coronary artery bypass (OPCAB) anastomosis, and that milrinone could ameliorate increases in MR that occur during OPCAB anastomosis. Subjects comprised 140 patients scheduled for elective OPCAB divided into three groups: patients without MR (MR(-) group; n = 57), patients with MR (MR(+) group; n = 41), and patients with MR who received milrinone (M+MR(+) group; n = 42). Patients with grade 1+ or 2+ MR were included, whereas those with grade 3+ or 4+ MR were excluded. Hemodynamic variables were measured after the induction of anesthesia and during anastomosis. IV infusion of milrinone (0.5 microg . kg(-1) . min(-1)) started immediately after the induction of anesthesia in the M+MR(+) group. CI was significantly decreased (P < 0.0001), and MPAP and MR were significantly increased (P < 0.001) during left coronary anastomosis in the MR(+) group compared with the MR(-) group. CI was significantly higher (P < 0.001), and neither MPAP nor MR were increased (P < 0.05) during left coronary artery anastomosis in the M+MR(+) group compared to the MR(+) group. In patients with MR, anastomosis of the left coronary artery branches was associated with decreased CI and increased regurgitation and MPAP. In such patients, treatment with milrinone helps to stabilize hemodynamics during anastomosis.
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kagoshima University, Sakuragaoka, Japan. omae@za2.so-net
Takeshi
T
Omae
Yasuyuki
Y
Kakihana
Akira
A
Mastunaga
Isao
I
Tsuneyoshi
Kouichi
K
Kawasaki
Yuichi
Y
Kanmura
Ryuzo
R
Sakata
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000758:Anesthesia; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D047549:Coronary Artery Bypass, Off-Pump; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D008944:Mitral Valve Insufficiency / Q000188:drug therapy* / Q000503:physiopathology*; D016343:Monitoring, Intraoperative; D009638:Norepinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D010138:Pacemaker, Artificial; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D020105:Milrinone; D004298:Dopamine; D009638:Norepinephrine