Inhaled Milrinone After Left Ventricular Assist Device Implantation.
BACKGROUND
Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation.


RESULTS
We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P = .017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively).


CONCLUSIONS
iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: nicholas.a.haglund@vanderbilt.edu.
Nicholas A
NA
Haglund
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Adam
A
Burdorf
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Tara
T
Jones
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Valerie
V
Shostrom
Cardiovascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
John
J
Um
Cardiovascular Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
Timothy
T
Ryan
Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska.
Sasha
S
Shillcutt
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Patricia
P
Fischer
Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee.
Zachary L
ZL
Cox
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Eugenia
E
Raichlin
Daniel R
DR
Anderson
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Brian D
BD
Lowes
Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
Ioana
I
Dumitru
D000280:Administration, Inhalation; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D006352:Heart Ventricles; D006353:Heart-Assist Devices / Q000639:trends*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage* / Q000191:economics; D011182:Postoperative Care / Q000191:economics / Q000379:methods; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000191:economics; D018497:Ventricular Dysfunction, Right / Q000517:prevention & control
D014665:Vasodilator Agents; D020105:Milrinone
Phosphodiesterase inhibitor; left ventricular assist device; nebulization; right ventricular dysfunction