The efficacy of intravenous milrinone in left ventricular restoration.
OBJECTIVE
The aim of this study was to clarify the efficacy of intravenous milrinone in postoperative care for patients following left ventricular (LV) restoration (LVR).


METHODS
Fourteen patients who had ischemic cardiomyopathy with an LV ejection fraction (LVEF) of less than 0.30 and an LV end-systolic volume index of more than 100 ml/m2 underwent coronary artery bypass grafting and concomitant LVR. The patients received perioperative management with continuous infusions of 0.5 microg/kg/min milrinone that were started at the induction of a cardiopulmonary bypass (CPB). The perioperative course and outcome of these patients were retrospectively compared with those of matched LVR patients (n = 14) without milrinone administration during perioperative management.


RESULTS
The preoperative LV end-diastolic pressure (26.3 mmHg vs. 15.4 mmHg) and early diastolic filling velocity/atrial filling velocity ratio (4.1 vs. 2.1) in the milrinone patients were significantly worse than those in the control. Even though the preoperative LV function in each patient demonstrated to be extremely poor, the perioperative hemodynamic variables were stable. The administered doses of dobutamine (4.01 vs. 5.81 microg/kg/min) and epinephrine (0.017 vs. 0.038 microg/kg/min) at the end of CPB were significantly lower in the milrinone patients compared to control.


CONCLUSIONS
In those patients who underwent LVR because of ischemic cardiomyopathy, the administration of milrinone achieved safe perioperative management for stable hemodynamics and reduced the postoperative doses of dobutamine and epinephrine.
Yamaguchi
Atsushi
A
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Japan.
Tanaka
Masashi
M
Naito
Kazuhiro
K
Kimura
Chieri
C
Kobinata
Toshiyuki
T
Okamura
Homare
H
Ino
Takashi
T
Adachi
Hideo
H
D000368:Aged; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004280:Dobutamine / Q000008:administration & dosage; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left / Q000187:drug effects*; D017725:Ventricular Pressure / Q000187:drug effects
D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D004280:Dobutamine; D020105:Milrinone; D004837:Epinephrine