title: The use of continuous milrinone therapy as bridge to transplant is safe in patients with short waiting times.
abstract: OBJECTIVE
  The limited availability of donor organs creates a need for more effective management of heart disease when bridging a patient to cardiac transplant. Inotropic therapy is becoming more commonly used long term to maintain baseline function. The effectiveness and complications associated with their use have not been fully evaluated, and indications for mechanical versus medical therapy as a bridge have not been delineated.
  
  
  RESULTS
  The purpose of this study is to evaluate the safety and efficacy of milrinone as a bridge to transplant. This was a retrospective study of 60 patients listed for a cardiac transplant and committed to home intravenous milrinone therapy. A subgroup of patients who eventually progressed to the use of a ventricular assist device were analyzed. Complications and survivals were analyzed for each group. Forty-six patients (76%) were successfully bridged to transplant with milrinone alone, and 14 patients' (24%) conditions deteriorated and required a left ventricular assist device (LVAD); 1-year survivals were 83% and 71%, respectively. The mean waiting time was 59.5 days (9-257 days) for patients receiving milrinone who did not require an LVAD and 112 days (24-270 days) for those whose conditions deteriorated to require an LVAD.
  
  
  CONCLUSIONS
  This study suggests that chronic intravenous milrinone provides an adequate strategy as a bridge to transplant if the waiting time is short (<100 days), whereas an elective ventricular assist device implantation may be a safer strategy for patients expected to wait longer. These data provide the basis for a prospective evaluation of inotrope versus LVAD as a bridge to transplantation.
authors.affiliation: Methodist DeBakey Heart Center, Houston, Texas 77030, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Assad-Kottner
authors.forename: David
authors.initials: D
authors.lastname: Chen
authors.forename: Jama
authors.initials: J
authors.lastname: Jahanyar
authors.forename: Francisco
authors.initials: F
authors.lastname: Cordova
authors.forename: Nathan
authors.initials: N
authors.lastname: Summers
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.forename: Ramanna
authors.initials: R
authors.lastname: Merla
authors.forename: Keith
authors.initials: K
authors.lastname: Youker
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000639:trends*; D006353:Heart-Assist Devices / Q000639:trends; D006699:Home Care Services / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014850:Waiting Lists
chemical_list: D020105:Milrinone