Effect of Milrinone on Short Term Outcome of Patients with Myocardial Dysfunction Undergoing Off-Pump Coronary Artery Bypass Graft: A Randomized Clinical Trial
-
Mehdi Hadadzadeh
,
Seyed Habib Hosseini
,
Seyed Mohammad Yousof Mostafavi Pour Manshadi
,
Nafiseh Naderi
,
Mahmood Emami Meybodi
Abstract
Myocardial dysfunction is a major complication in cardiac surgery that needs inotropic support. This study evaluates the effect of milrinone on patients with low ventricular ejection fraction undergoing off- pump coronary artery bypass graft (OPCAB). The present study is designed to evaluate the effect of milrinone on myocardial dysfunction. Eighty patients with low ventricular ejection fraction (<35%), candidate for elective OPCAB, were enrolled in this study. They were randomly assigned to two groups. One group received milrinone (50 μg/kg) intravenously and another group received a saline as placebo followed by 24 hours infusion of each agent (0.5 μg/kg/min). Short outcome of patients such as hemodynamic parameters and left ventricular ejection fraction were variables evaluated. Serum levels of creatine phosphokinase, the MB isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration of mechanical ventilation were significantly lower in milrinone group (P<0.05). The mean post operative left ventricular ejection fraction was significantly higher in milrinone group (P=0.031). There were no statistical significant differences between the two groups in terms of intra-aortic balloon pump, inotropic support requirement, myocardial ischemia, myocardial infarction, duration of inotropic support, duration of intensive care unit stay, mortality and morbidity rate. Administration of milrinone in patients undergoing OPCAB with low ventricular ejection fraction is useful and effective.
Heringlake M, Wernerus M, Grunefeld J, Klaus S, Heinze H, Bechtel M, Bahlmann L, Poeling J, Schön J. The metabolic and renal effects of adrenaline and milrinone in patients with myocardial dysfunction after coronary artery bypass grafting. Crit Care 2007;11(2):R51.
Hart JC, Spooner TH, Pym J, Flavin TF, Edgerton JR, Mack MJ, Jansen EW. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg 2000;70(3):1017-20.
Porat E, Sharony R, Ivry S, Ozaki S, Meyns BP, Flameng WJ, Uretzky G. Hemodynamic changes and right heart support during vertical displacement of the beating heart. Ann Thorac Surg 2000;69(4):1188-91.
Abu-Omar Y, Taggart DP. The present status of off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2009;36(2):312-21.
Jeon Y, Ryu JH, Lim YJ, Kim CS, Bahk JH, Yoon SZ, Choi JY. Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. Eur J Cardiothorac Surg 2006;29(6):952–6.
Nierich AP, Diephuis J, Jansen EW, Borst C, Knape JT. Heart displacement during off-pump CABG: how well is it tolerated? Ann Thorac Surg 2000;70(2):466-72.
Costachescu T, Denault A, Guimond JG, Couture P, Carignan S, Sheridan P, Hellou G, Blair L, Normandin L, Babin D, Allard M, Harel F, Buithieu J. The hemodynamically unstable patient in the intensive care unit: hemodynamic vs. transesophageal echocardiographic monitoring. Crit Care Med 2002;30(6):1214–23.
Bernard F, Denault A, Babin D, Goyer C, Couture P, Couturier A, Buithieu J. Diastolic dysfunction is predictive of difficult weaning from cardiopulmonary bypass. Anesth Analg 2001;92(2):291–8.
Avery GJ 2nd, Ley SJ, Hill JD, Hershon JJ, Dick SE. Cardiac surgery in the octogenarian: Evaluation of risk, cost, and outcome. Ann Thorac Surg 2001;7(2)1:591–6.
Liu J, Tanaka N, Murata K, Ueda K, Wada Y, Oyama R,nMatsuzaki M. Prognostic value of pseudonormal and restrictive filling patterns on left ventricular remodeling and cardiac events after coronary artery bypass grafting. Am J Cardiol 2003;91(5):550–4.
Liu LL, Gropper MA. Respiratory and hemodynamic management after cardiac surgery. Curr Treat Options Cardiovasc Med 2002;4(2):161–9.
Feneck RO, Sherry KM, Withington PS, Oduro- Dominah A. European Milrinone Multicenter Trials Group. Comparison of the hemodynamic effects of milrinone with dobutamine in patients after cardiac surgery. J Cardiothorac Vasc Anesth 2001;15(3):306–15.
Kikura M, Levy JH, Michelsen LG, Shanewise JS, Bailey JM, Sadel SM, Szlam F. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg 1997;85(1):16-22.
Monrad ES, Baim DS, Smith HS, Lanoue AS. Milrinone, dobutamine, and nitroprusside: comparative effects on hemodynamics and myocardial energetics in patients with severe congestive heart failure. Circulation 1986;73(3 Pt1):III 168-74.
Lobato EB, Gravenstein N, Martin TD. Milrinone, not epinephrine, improves left ventricular compliance after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000;14(4):374–7.
Solina A, Papp D, Ginsberg S, Krause T, Grubb W, Scholz P, Pena LL, Cody R. A comparison of inhaled nitric oxide and milrinone for the treatment of pulmonary hypertension in adult cardiac surgery patients. J Cardiothorac Vasc Anesth 2000; 14(1):12–7.
Kwak YL, Oh YJ, Shinn HK, Yoo KJ, Kim SH, Hong YW. Haemodynamic effects of a milrinone infusion without a bolus in patients undergoing off-pump coronary artery bypass graft surgery. Anaesthesia 2004;59(4):324-31.
Feneck RO. Effect of variable dose milrinone in patients with low cardiac output after cardiac surgery. European Multicenter Trial Group. Am Heart J 1991;121(6 Pt2):1995-9.
Monrad ES, McKay RG, Baim DS, Colucci WS, Fifer MA, Heller GV, Royal HD, Grossman W. Improvement in indexes of diastolic performance in patients with congestive heart failure treated with milrinone. Circulation 1984;70(6):1030–7.
Maslow AD, Regan MM, Schwartz C, Bert A, Singh A. Inotropes improve right heart function in patients undergoing aortic valve replacement for aortic stenosis. Anesth Analg 2004;98(4):891–902.
Lobato EB, Willert JL, Looke TD, Thomas J, Urdaneta F. Effects of milrinone versus epinephrine on left ventricular relaxation after cardiopulmonary bypass following myocardial revascularization: assessment by color m-mode and tissue Doppler. J Cardiothorac Vasc Anesth 2005;19(3):334–9.
Kikura M, Levy JH, Bailey JM, Shanewise JS, Michelsen LG, Sadel SM. A bolus dose of 1.5 mg/kg amrinone effectively improves low cardiac output state following separation from cardiopulmonary bypass in cardiac surgical patients. Acta Anaesthesiol Scand 1998;42(7):825–33.
Rathmell JP, Prielipp RC, Butterworth JF, Williams E, Villamaria F, Testa L, Viscomi C, Ittleman FP, Baisden CE, Royster RL. A multicenter, randomized, blind comparison of amrinone with milrinone after elective cardiac surgery. Anesth Analg 1998;86(4):683–90.
Bailey JM, Levy JH, Kikura M, Szlam F, Hug CC Jr. Pharmacokinetics of intravenous milrinone in patients undergoing cardiac surgery. Anesthesiology 1994;81(3):616–22.
Wright EM, Sherry KM. Clinical and haemodynamic effects of milrinone in the treatment of low cardiac output after cardiac surgery. Br J Anaesth 1991;67(5):585–90.
Kikura M, Levy JH, Michelsen LG, Shanewise JS, Bailey JM, Sadel SM, Szlam F. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg 1997;85(1):16–22.
Oztekin I, Yazici S, Oztekin DS, Goksel O, Issever H,,Canik S. Effects of low-dose milrinone on weaning from cardiopulmonary bypass and after in patients withmitralstenosis and pulmonary hypertension. Yakugaku Zasshi 2007;127(2):375-83.
Yamaguchi A, Tanaka M, Naito K, Kimura C, Kobinata T, Okamura H, The efficacy of intravenous milrinone in left ventricular restoration. Ann Thorac Cardiovasc Surg 2009;15(4):233-8.
Levy JH, Bailey JM, Deeb GM. Intravenous milrinone in cardiac surgery. Ann Thorac Surg 2002;73(1):325-30.
Konstam MA, Cody RJ. Short-term use of intravenous milrinone for heart failure. Am J Cardiol 1995;75(12):822–6.
George M, Lehot JJ, Estanove S. Haemodynamic and biological effects of intravenous milrinone in patients with a low cardiac output syndrome following cardiac surgery: multicentre study. Eur J Anaesthesiol 1992;5:31–4.
Couture P, Denault AY, Pellerin M, Tardif JC. Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery. Can J Anaesth 2007;54(7):509-22.
Jebeli M, Ghazinoor M, Mandegar MH, Rasouli MR,m Eghtesadi-Araghi P, Goodarzynejad H, Mohammadzadeh R, Darehzereshki A, Dianat S. Effect of milrinone on shortterm outcome of patients with myocardial dysfunctionundergoing coronary artery bypass graft: A randomizedcontrolled trial. Cardiol J 2010;17(1):73-8.
Gorodeski EZ, Chu EC, Reese JR, Shishehbor MH, Hsich E, Starling RC. Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure. Circ Heart Fail 2009;2:320-4.
Zangrillo A, Biondi-Zoccai G, Ponschab M, Greco M, Corno L, Covello RD, Cabrini L, Bignami E, Melisurgo G, Landoni G. Milrinone and mortality in adult cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2012;26(1):70-7.
Jo HR, Lee WK, Kim YH, Min JH, Chae YK, Choi IG, Kim YS, Lee YK. The effect of milrinone infusion on right ventricular function during coronary anastomosis andearly outcomes in patients undergoing off-pump coronary artery bypass surgery. Korean J Anesthesiol 2010;59:92-8.
Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, Hoff SJ, Ball SK, Brown NJ, Pretorius M. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation 2008; 118(16):1619-25.
Feneck RO. Intravenous milrinone following cardiac surgery: I. Effects of bolus infusion followed by variabledose maintenance infusion. The European Milrinone Multicentre Trial Group. J Cardiothorac Vasc Anesth 1992;6(5):554-62.
| Files | ||
| Issue | Vol 51, No 10 (2013) | |
| Section | Original Article(s) | |
| Keywords | ||
| Low ventricular ejection fraction Milrinone Myocardial dysfunction Off-pump coronary artery bypass graft | ||
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