Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery

Couture, Pierre; Denault, André; Pellerin, Michel; Tardif, Jean‐Claude

doi:10.1007/bf03022314

Cited by 48 publications

(44 citation statements)

References 30 publications

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“…21,22 For patients with pulmonary hypertension, pulmonary vasodilators have been shown to improve outcomes. 23,24 For the restrictive LV, milrinone has had mixed results 25,26 whereas close monitoring and optimization of volume status and filling pressures remains the mainstay.…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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Background— Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. Methods and Results— Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. Conclusions— Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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“…1 Studies have suggested that intravenous milrinone may be beneficial in the treatment of PH in cardiac surgery. 2,3 Nevertheless, intravenous milrinone has been associated with systemic hypotension 4 and increased vasoactive drug requirements 5 as well as increased morbidity 6 and mortality after cardiac surgery. 7 The use of inhaled milrinone (iMil) has been described in several animal 8,9 and human reports.…”

Section: Résumémentioning

confidence: 99%

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Denault

Bussières

Arellano

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Inhaled milrinone (iMil) has been used for the treatment of pulmonary hypertension (PH) but its efficacy, safety, and prophylactic effects in facilitating separation from cardiopulmonary bypass (CPB) and preventing right ventricular (RV) dysfunction have not yet been evaluated in a clinical trial. The purpose of this study was to investigate if iMil administered before CPB would be superior to placebo in facilitating separation from CPB.Methods High-risk cardiac surgical patients with PH were randomized to receive iMil or placebo after the induction of anesthesia and before CPB. Hemodynamic parameters and RV function were evaluated by means of pulmonary artery catheterization and transesophageal echocardiography. The groups were compared for the primary outcome of the level of difficulty in weaning from CPB. Among the secondary outcomes examined were the reduction in the severity of PH, the incidence of RV failure, and mortality. Results Of the 124 patients randomized, the mean (standard deviation [SD]) EuroSCORE II was 8.0 (2.6), and the baseline mean (SD) systolic pulmonary artery pressure (SPAP) was 53 (9) mmHg. The use of iMil was associated with increases in cardiac output (P = 0.03) and a reduction in SPAP (P = 0.04) with no systemic hypotension. Nevertheless, there was no difference in the combined incidence of difficult or complex separation from CPB between the iMil and control groups (30% vs 28%, respectively; absolute difference, 2%; 95% confidence interval [CI], -14 to 18; P = 0.78). There was also no difference in RV failure between the iMil and control groups (15% vs 14%, respectively; difference, 1%; 95% CI, -13 to 12; P = 0.94). Mortality was increased in patients with RV failure vs those without (22% vs 2%, respectively; P \ 0.001). Conclusion In high-risk cardiac surgery patients with PH, the prophylactic use of iMil was associated with favourable hemodynamic effects that did not translate into improvement of clinically relevant endpoints. This trial was registered at ClinicalTrials.gov; identifier: NCT00819377. RésuméObjectif La milrinone inhalée est utilisée pour traiter l'hypertension pulmonaire (HP) mais son efficacité, son innocuité et ses effets prophylactiques pour faciliter le sevrage de la circulation extracorporelle (CEC) et prévenir la dysfonction ventriculaire droite (VD) n'ont pas encore été évalués dans le cadre d'une étude clinique. L'objectif de cette étude était d'examiner si la milrinone inhalée avant la CEC serait supérieure à un placebo pour faciliter le sevrage de la CEC. Méthode Des patients de chirurgie cardiaque à risque élevé et souffrant d'HP ont été randomisés à recevoir de la milrinone inhalée ou un placebo après l'induction de l'anesthésie et avant la CEC. Les paramètres hémodynamiques et la fonction VD ont été évalués à l'aide d'un cathéter de l'artère pulmonaire et d'une échocardiographie transoesophagienne. Les groupes ont été comparés selon notre critère d'évaluation principal, soit le niveau de difficulté du sevrage de la CEC. Parmi les critères...

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“…Characteristics of the study population and the awake population Individual data sets were obtained from 304 patients in seven published studies (3,(14)(15)(16)(17)(18)(19) and from 85 patients in one unpublished study (Table 1). In all studies, LV EDA and ESA were measured using manual planimetry of the endocardial boarders at end-diastole and end-systole according to the guidelines provided by Lang et al (21).…”

Section: Resultsmentioning

confidence: 99%

“…This is individual-level data analysis including data from several published studies (3,(14)(15)(16)(17)(18)(19). All patient data from studies included in this analysis were approved by the local institutional review boards, and written informed consent was obtained from all included patients.…”

Section: Methodsmentioning

confidence: 99%

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Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

Bolliger¹,

Poltera²,

Cheung³

et al. 2018

Turk J Anaesth Reanim

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Objective: Normative values for left ventricular (LV) end-diastolic area (EDA) and diameter (EDD) for intra-operative transoesophageal echocardiography (TOE) have not been established. We aimed to define the ranges of LV EDA and EDD for intra-operative TOE examinations in patients undergoing coronary artery bypass graft (CABG) surgery. Methods: A MEDLINE search for studies reporting LV EDA and EDD in patients undergoing CABG surgery was performed. Individual-level data set from 333 anaesthetised and ventilated patients with preserved LV function (study population) was obtained from eight studies. EDA and calculated EDD in the study population were compared with summary EDD values obtained using transthoracic echocardiography (TTE) in two studies of 500 awake patients with coronary artery disease (CAD). Further, the influence of pre-specified factors on EDD was evaluated in a multivariate regression model. Results: The EDA and EDD values measured using TOE in the anaesthetised CABG patients were 16.7±4.7 cm 2 and 4.6±0.6 cm, respectively. TOE values of EDD in anaesthetised patients were 10%-13% less than those measured using TTE in two studies of awake patients (p<0.001). Body surface area, age and fractional area change, but not sex were factors that affected LV EDD. Conclusion:The values for LV EDD measured through intra-operative TOE in anaesthetised ventilated CABG patients were 10%-13% less than the corresponding values measured using TTE in awake CAD patients. This finding indicates that independent normative values specific for intra-operative TE should be established for guiding intra-operative clinical decisions. Keywords: Echocardiography, transthoracic echocardiography, transesophageal echocardiography, cross-sectional, coronary artery bypass surgery Amaç: İntraoperatif transözofajiyal ekokardiyografi (TOE) için sol ventrikül (SV) diyastol sonu alanı (EDA) ve çapının (EDD) normal değerleri belirlenmemiştir. Bu çalışmanın amacı, koroner arter bypass greft (KABG) ameliyatı geçiren hastalarda yapılan intraoperatif TOE incelemeleri için SV EDA ve EDD aralıklarını tanımlamaktır. Yöntemler: KABG ameliyatı geçiren hastalarda SV EDA ve EDD değerlerini rapor eden çalışmalar için bir MEDLINE araştırması yapıldı. Korunmuş SV fonksiyonu olan 333 anestezi ve ventilasyon uygulanmış hastanın (çalışma popülasyonu) bireysel verileri 8 çalışmadan elde edildi. Çalışma popülasyonundaki EDA ve hesaplanmış EDD değerleri, koroner arter hastalığı (KAH) olan 500 bilinçli hastayı içeren iki çalışmada transtorasik ekokardiyografi (TTE) kullanarak elde edilen özet EDD değerleri ile karşılaştırıl-dı. Ayrıca, önceden belirlenmiş faktörlerin EDD üzerindeki etkisi multivaryant regresyon modeli kullanılarak değerlendirildi. Bulgular: Anestezi altındaki KABG hastalarında TOE kullanılarak ölçülen EDA ve EDD değerleri sırasıyla 16,7±4,7 cm 2 ve 4,6±0,6 cm olarak bulundu. Anestezi uygulanan hastalarda TOE ve EDD değerleri, bilinçli hastalar üzerinde yapılan iki çalışmada TTE kullanılarak ölçülen değerlere göre %10-%13 daha düşüktü (p<0,00...

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Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery

Cited by 48 publications

References 30 publications

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

Assessment of Left Ventricular Dimensions by Transoesophageal Echocardiography in Patients During Coronary Artery Bypass Surgery

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