Effect of milrinone on short-term outcome of patients with myocardial dysfunction undergoing coronary artery bypass graft: A randomized controlled trial.
BACKGROUND
Myocardial dysfunction needing inotropic support is a typical complication after on-pump cardiac surgery. In this study, we evaluate the effect of milrinone on patients with ventricular dysfunction undergoing coronary artery bypass graft (CABG).


METHODS
Seventy patients with impaired left ventricular function [left ventricular ejection fraction (LVEF) < 35%] undergoing on-pump CABG were enrolled. Patients were randomized to receive either an intraoperative bolus of milrinone (50 microg/kg) or saline as placebo followed by a 24-hour infusion of each agent (0.5 microg/kg/min). Hemodynamic parameters and transthoracic echocardiographic measurement of systolic and diastolic functions were the variables evaluated.


RESULTS
Serum levels of creatine phosphokinase (CPK), the MB isoenzyme of creatine kinase (CK-MB), occurrence of myocardial ischemia or infarction, and mean duration of using inotropic agents were significantly lower in the milrinone group (p < 0.05). There were no significant differences between the two groups regarding the development of ventricular arrhythmia, duration of cardiopulmonary bypass, intra-aortic balloon pump and inotropic support requirement, duration of mechanical ventilation, duration of intensive care unit stay and mortality rate. Although mean pre-operative LVEF was significantly lower in the milrinone group, there was no significant difference between post-operative LVEFs.


CONCLUSIONS
We suggest that perioperative administration of milrinone in patients undergoing on-pump CABG, especially those with low LVEF, is beneficial.
Jebeli
Mohammad
M
Cardiac Surgery Department, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
Ghazinoor
Mohammad
M
Mandegar
Mohammad Hussein
MH
Rasouli
Mohammad R
MR
Eghtesadi-Araghi
Payam
P
Goodarzynejad
Hamidreza
H
Mohammadzadeh
Robabeh
R
Darehzereshki
Ali
A
Dianat
Saied
S
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D004334:Drug Administration Schedule; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology; D019990:Perioperative Care; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*
D002316:Cardiotonic Agents; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D020105:Milrinone