Milrinone and Low Cardiac Output Following Cardiac Surgery in Infants: Is There a Direct Myocardial Effect?

Duggal, Bhanu; Pratap, Usha; Slavík, Zdeněk; Kaplanová, Jana; MacRae, Duncan

doi:10.1007/s00246-005-0881-z

Cited by 35 publications

(15 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In terms of efficacy issue, fractional shortening and ejection fraction were both improved after milrinone infusion in group A patients, which is in consistent with previous findings 9)11). Chang et al9) reported that milrinone treatment in neonates with low cardiac output after congenital heart surgery improved the cardiac index without changing myocardial oxygen consumption.…”

Section: Discussionsupporting

confidence: 89%

“…Chang et al9) reported that milrinone treatment in neonates with low cardiac output after congenital heart surgery improved the cardiac index without changing myocardial oxygen consumption. Duggal et al11) documented that milrinone therapy improved the left and right myocardial performance index, a reliable index that reflects myocardial contractility.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

et al. 2014

View full text Add to dashboard Cite

Background and ObjectivesMilrinone is often used in children to treat acute heart failure and prevent low cardiac output syndrome after cardiac surgery. Due to the lack of studies on the long-term milrinone use in children, the objective of this study was to assess the safety and efficacy of the current patterns of milrinone use for ≥3 days in infants and children with heart diseases.Subjects and MethodsWe retrospectively reviewed the medical records of patients aged <13 years who received milrinone for ≥3 days from January 2005 to December 2012. Patients' characteristics including age, sex, height, weight, and body surface area were recorded. The following parameters were analyzed to identify the clinical application of milrinone: initial infusion rate, maintenance continuous infusion rate, total duration of milrinone therapy, and concomitantly infused inotropes. The safety of milrinone was determined based on the occurrence of adverse events such as hypotension, arrhythmia, chest pain, headache, hypokalemia, and thrombocytopenia.ResultsWe assessed 730 admissions (684 patients) during this period. Ventricular septal defects were the most common diagnosis (42.4%) in these patients. Milrinone was primarily used after cardiac surgery in 715 admissions (97.9%). The duration of milrinone treatment varied from 3 to 64.4 days (≥7 days in 149 admissions). Ejection fraction and fractional shortening of the left ventricle improved in patients receiving milrinone after cardiac surgery. Dose reduction of milrinone due to hypotension occurred in only 4 admissions (0.5%). Although diverse arrhythmias occurred in 75 admissions (10.3%), modification of milrinone infusion to manage arrhythmia occurred in only 3 admissions (0.4%). Multivariate analysis indicated that the development of arrhythmia was not influenced by the pattern of milrinone use.ConclusionMilrinone was generally administered for ≥3 days in children with heart diseases. The use of milrinone for ≥3 days was effective in preventing low cardiac output after cardiac surgery when combined with other inotropes, suggesting that milrinone could be safely employed in pediatric patients with heart diseases.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Another, recently published study investigated 15 infants within the first 16 month of life with post cardiac surgery LOCS. As in the previous studies, this work also confirmed a direct myocardial effect of milrinone as improvement in biventricular myocardial function measured by Doppler-derived, time interval-based index of myocardial performance [23].…”

Section: Phosphodiesterase Inhibitorssupporting

confidence: 87%

New Inotropic Pharmacologic Strategies Targeting the Failing Myocardiumin the Newborn and Infant

Veldman

Rupp²,

Schranz³

2006

MRMC

View full text Add to dashboard Cite

Pharmacologic support of the failing neonatal heart to maintain cardiac output, which is vital for sufficient end organ perfusion, is a challenging task for the pediatric intensivist, especially since strategies which have been proven to be effective in adults cannot necessarily be extrapolated to neonates. The unique biochemical properties and structure of the neonatal heart, including the increased non-contractile tissue mass, a lower responsiveness to beta adrenergic agents and the heart rate dependent cardiac output with a limited ability to increase stroke volume, favor some of the new inotropes of the Ca+ sensitizer family. Focusing on the after load reduction, inodilators as phosphodiesterase inhibitors and human brain natriuretic peptide offer treatment options for the neonatal myocardium. Additionally, thyroxine and steroids have been investigated in neonates with low cardiac output after surgery for congenital heart disease. Gene therapy, in particular cardiac-selective gene transfer, might offer perspectives for future support for the neonatal heart. This text reviews some of the most recent pharmacologic strategies targeting the failing myocardium in the critically ill newborn and infant.

show abstract

“…Treatment with milrinone led to im-provement in biventricular myocardial function [mean right ventricular index from 0.521±0.213 to 0.385±0.215, (P=0.003), mean left ventricular index from 0.636±0.209 to 0.5±0.171 (P= 0.012). No difference was found in the values of heart rate between groups [17].…”

Section: Discussionmentioning

confidence: 72%

Comparison of early and late intravenous infusion of milrinone in pediatric patients undergoing cardiac surgery

Soliman¹,

Yousef²,

Ragheb³

et al. 2012

J Anesthesiol Clin Sci

View full text Add to dashboard Cite

Objective: This study was done to compare the effects of early and late use of milrinone in pediatric patients undergoing complex cardiac surgery. Design:The study was a prospective randomized study. Setting: Prince Sultan cardiac center, Saudi Arabia. Methods:A prospective study involved 40 pediatric patients undergoing congenital corrective cardiac surgery, classified randomly into two groups (N=20). Group A: Milrinone infusion was started without loading dose, at 0.5mcg/kg/min at the beginning of CPB and continued postoperatively (0.5-0.75 mcg/kg/min) in the PCICU. Group B: Milrinone was started as a loading dose 50mcg/kg over 10 min after aortic declamping and continued as infusion (0.5-0.75 mcg/kg/min) postoperatively in the PCICU. Data were collected at baseline, 1 st , 6 th , 12 th , and 24 th postoperative hours in the ICU. Results:The inotropic supports and mechanical supports were needed more in group B than group A. The comparison of heart rate, CVP, temperature, hemoglobin, SpO2 and PaCO2, were insignificant between the two groups (P>0.05). The mean arterial blood pressure through the first 6 hours postoperatively was higher in group A than group B (P<0.05), but became insignificant through other timepoints. The urine output and central venous oxygen saturation were higher in group A than group B (P<0.05).The serum lactate levels were significantly higher in group B more than group A (P<0.05).Conclusion: early use of milrinone, lead to easy weaning from CPB , decreased requirement of pharmacological and mechanical support and decreased the incidence of low cardiac output syndrome after pediatric cardiac surgery and there was no complications related to milrinone in our study patients.

show abstract

Milrinone and Low Cardiac Output Following Cardiac Surgery in Infants: Is There a Direct Myocardial Effect?

Cited by 35 publications

References 20 publications

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

Safety and Efficacy of the Off-Label Use of Milrinone in Pediatric Patients with Heart Diseases

New Inotropic Pharmacologic Strategies Targeting the Failing Myocardiumin the Newborn and Infant

Comparison of early and late intravenous infusion of milrinone in pediatric patients undergoing cardiac surgery

Contact Info

Product

Resources

About