The effect of milrinone on mortality in adult patients who underwent CABG surgery: a systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

Abstract

Background: As an inodilator, milrinone is commonly used for patients who undergo coronary artery bypass graft (CABG) surgery because of its effectiveness in decreasing the cardiac index and mitral regurgitation. The aim of this study was to perform a systematic review and meta-analysis of existing studies from the past 20 years to evaluate the impact of milrinone on mortality in patients who undergo CABG surgery. Methods: We performed a systematic literature search on the application of milrinone in patients who underwent CABG surgery in studies published between 1997 and 2017 in BioMed Central, PubMed, EMBASE, and the Cochrane Central Register. The included studies evaluated milrinone groups compared to groups receiving either placebo or standard treatment and further compared the systemic administration. Results: The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significant difference in mortality between the milrinone group and the placebo/standard care group when patients underwent CABG surgery. In addition, 9 trials (with 440 randomized patients), 4 trials (with 212 randomized patients), and 10 trials (with 470 randomized patients) reported that the occurrence of myocardial infarction (MI), myocardial ischemia, and arrhythmia was lower in the milrinone group than in the placebo/standard care group. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction, myocardial ischemia, and arrhythmia was significantly different. However, the occurrence of stroke and renal failure, the duration of inotropic support (h), the need for an intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences.

The Long-Term Association between Physical Activity and Weight Regain, Metabolic Risk Factors, Quality of Life and Sleep after Bariatric Surgery

“…Metabolic risk factors seem to be kept low during the process, although physical activity and exercise will help a better control in the long term [ 14 ]. A recent study suggested that physical activity after bariatric surgery might be associated with additional weight loss and more effective long-term weight control [ 15 ]. Therefore, it seems clear that an active lifestyle is essential to optimize and maintain weight control after bariatric surgery.…”

New strategy of using double-network hydrogel extravascular stent for preventing venous graft restenosis after coronary artery bypass grafting

“…Great saphenous veins are the most common source of vascular bridges for CABG, and the incidence of postoperative restenosis is very high, with a restenosis (2). DNHES significantly increased luminal area (A), reduced new intimal area (B) and the degree of luminal stenosis (C) compared with untreated group, n = 12.…”

“…Figure 3. DNHES reduces intimal and medial thickening in venous grafts(2). DNHES significantly increased luminal area (A), reduced new intimal area (B) and the degree of luminal stenosis (C) compared with untreated group, n = 12.…”

Patient-, Clinician-, and Institution-level Variation in Inotrope Use for Cardiac Surgery: A Multicenter Observational Analysis

“…The population had a mean age of 64 yr, 31.4% were women, and 76.5% were White (table 1). Cardiac surgeries performed included valve (22,987,45.0% of cases), coronary artery bypass (20,681, 40.5%), and valve/coronary artery bypass combination (7,414, 14.5%).…”

“…Should such trials be pursued, it should be noted that one-size-fitsall strategies to inotrope use after cardiac surgery, which have historically yielded indeterminate or conflicting conclusions, are unlikely to be effective. [43][44][45] Rather, inotrope administration strategies that account for the heterogeneity of treatment effects and dynamic patient recovery trajectories across diverse surgical populations may be necessary to guide optimal inotrope use for cardiac surgery. Indeed, within a broader perioperative care context, the need to reduce components of variation negatively affecting outcomes not by introducing more standardized therapies but rather by introducing more patient-centered therapies has been underscored in shortcomings to recent clinical trial designs comparing interventions in a one-size-fits all fashion.…”