title: Preliminary experience with combined inhaled milrinone and prostacyclin in cardiac surgical patients with pulmonary hypertension.
abstract: OBJECTIVE
  To retrospectively evaluate the effects of combined inhaled prostacyclin and milrinone to reduce the severity of pulmonary hypertension when administered prior to cardiopulmonary bypass.
  
  
  METHODS
  Retrospective case control analysis of high-risk patients undergoing cardiac surgery.
  
  
  METHODS
  Single cardiac center.
  
  
  METHODS
  Sixty one adult cardiac surgical patients with pulmonary hypertension, 40 of whom received inhalation therapy.
  
  
  METHODS
  Inhaled milrinone and inhaled prostacyclin were administered before cardiopulmonary bypass (CPB).
  
  
  RESULTS
  Administration of both inhaled prostacyclin and milrinone was associated with reductions in central venous pressure, and mean pulmonary artery pressure, increases in cardiac index, heart rate, and the mean arterial-to-mean pulmonary artery pressure ratio (p < 0.05), with no significant change in mean arterial pressure. The rate of difficult and complex separation from CPB was 51% in the inhaled group and 70% in the control group (p = 0.1638). Postoperative vasoactive requirement was reduced at 12 hours (35.9 v 73.7% p<0.01) and 24 hours (25.6 v 57.9% p<0.05) postoperatively in the combined inhaled agent group. Hospital length of stay and mortality were similar between the groups.
  
  
  CONCLUSIONS
  Preemptive treatment of pulmonary hypertension with a combination of inhaled prostacyclin and milrinone before CPB was associated with a reduction in the severity of pulmonary hypertension. In addition, a significant reduction in vasoactive support in the intensive care unit during the first 24 hours after cardiac surgery was observed. The impact of this strategy on postoperative survival needs to be determined.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Maxime
authors.initials: M
authors.lastname: Laflamme
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Elmi-Sarabi
authors.affiliation: Department of Biostatistics, Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada. Electronic address: andre.denault@gmail.com.
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage*; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D011464:Epoprostenol; D020105:Milrinone
keywords: cardiac surgery; cardiopulmonary bypass; epoprostenol; milrinone; prostacyclin; pulmonary hypertension