The Effect of Milrinone on the Right Ventriclular Function in Patients with Reduced Right Ventricular Function Undergoing Off-pump Coronary Artery Bypass Graft Surgery

Lee, Jong Hwa; Oh, Young Jun; Shim, Yon Hee; Hong, Yong Woo; Yi, Gijong; Kwak, Young Lan

doi:10.3346/jkms.2006.21.5.854

Cited by 18 publications

(22 citation statements)

References 22 publications

(25 reference statements)

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“…Of these, the most common reasons for exclusion were as follows: valid data could not be obtained by the authors (87 studies), milrinone was compared with other drugs (17 studies), pediatric populations were used (11 studies), studies were nonrandomized controlled trials (9 studies), crossover studies (5 studies), studies published as abstracts only (4 studies), studies used mechanical devices as controls (4 studies), studies used inhaled milrinone (3 studies), studies used randomization of brain-dead organ donors (3 studies), studies were animal studies (2 studies), and studies used healthy volunteers (1 study). Ultimately, sixteen randomized clinical trials were assessed in compliance with the inclusion criteria (Table 1) [31,[38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Section: Resultsmentioning

confidence: 99%

“…The total number of patients in the 16 included trials was 698, who underwent CABG surgery (346 treated with placebo/standard care and 352 treated with milrinone) ( Table 2 and Table 3). In ve of these studies, off-pump CABG surgery was performed [31,41,45,46,49], and on-pump CABG surgery was performed in 11 studies [39-45, 48, 49, 51, 52]. As the result showed, the mortality of on-pump CABG between milrinone treatment and placebo/standard care groups, the occurrence was [5/139 (3.59 %) vs. 4/146 (2.74 %), odds ratio (OR) = 1.17 (0.37-3.72), p value = 0.649, I-squared = 0.0%].…”

Section: Study Characteristicsmentioning

confidence: 99%

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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

Ren¹,

Li²,

Peng³

et al. 2020

Preprint

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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.Conclusions: Based on the current results, compared with placebo, milrinone might be unable to decrease mortality in adult CABG surgical patients but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmia. These results provide evidence for the further clinical application of milrinone and of therapeutic strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient data from randomized clinical trials need to be collected, and the potential benefits and adverse effects should be analyzed and reevaluated.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

Ren¹,

Li²,

Peng³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Ultimately, sixteen randomized clinical trials were assessed in compliance with inclusion ( Table 1). 32,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]…”

Section: Resultsmentioning

confidence: 99%

“…27,28 Milrinone, one of the PDE III inhibitors, primarily used after openheart surgery because it can avoid cardiopulmonary bypass, 29 enhances cardiac contractility, 30 prevents vasospasm, 31 and ameliorates low output syndrome (LOS). (32) However, recent studies have demonstrated that the efficacy and safety profile of milrinone remain controversial, although it is implemented in several guidelines. 33,34 In some cardiac surgeries, the tendency of increasing mortality and incidence of arrhythmia was found in milrinone group, comparing with control agents.…”

Section: Introductionmentioning

confidence: 99%

The effect of milrinone on mortality in adult patients: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

Ren¹,

Li²,

Peng³

et al. 2019

Preprint

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OBJECTIVE: Milrinone is commonly used for patients performed coronary artery bypass graft surgery (CABG) because of its effectiveness in decreasing cardiac index and mitral regurgitation. This study was to perform a systematic meta-analysis of existing studies in the past 20 years to evaluate the impact of milrinone on mortality in patients undergoing CABG surgery. EASUREMENTS AND MAIN RESULTS: The network meta-analysis included 723 patients from 16 randomized clinical trials. Overall, there was no significantly difference in mortality between the milrinone group and the placebo/standard care group [11/352 (3.13%) vs. 9/346 (2.60%), risk ratio = 1.18 (0.53–2.62), p for effect = 0.69, I 2 = 0 %] when patients underwent CABG surgery. Besides that, 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 arrhythmias in the milrinone group were decreased in comparsion with the placebo/standard care group, respectively. Between the milrinone treatment and placebo/standard care groups, the occurrence of myocardial infarction was [5/219 (2.28 %) vs. 25/212 (17.79 %), odds ratio(OR) = 0.19 (0.08–0.49), p value = 0.0005, I 2 = 5%], the occurrence of myocardial ischemia was [12/106 (11.32 %) vs. 41/106 (36.68 %), OR = 0.20 (0.10–0.42), p value <0.0001, I 2 = 0 %], and the occurrence of arrhythmias was [16/234 (6.84 %) vs. 31/236 (13.14 %), OR= 0.46 (0.24–0.88), p value = 0.02, I 2 =0 %]. However, the occurrence of stroke and renal failure, duration of inotropic support (h), need for intra-aortic balloon pump (IABP), and mechanical ventilation (h) between these two groups showed no differences. CONCLUSION: Based on the current results, milrinone might be unable to decrease the mortality in adult CABG surgical patients, but can significantly ameliorate the occurrence of MI, myocardial ischemia, and arrhythmias compared with placebo-treated patients. These results provide evidence for further clinical application of milrinone and therapy strategies for CABG surgery. However, along with milrinone application in clinical use, sufficient randomized clinical trials need to be collected, and the potential benefit and adverse effects should be analyzed and reevaluated.

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“…It is widely used alone or in combinations in patients with decompensated heart failure, particularly in those with nonischemic left ventricular systolic dysfunction (Mehra et al 1997; elker et al 2003) and cardiac surgery patients (Levy et al 2002; Lee et al 2006). In animal models of both acute and chronic pulmonary hypertension, milrinone significantly reduced PVR and improved RV function (Chen et al 1997; Hashiba et al 2000).…”

Section: Management Of Arterial Pulmonary Hypertension In Noncardiac Icumentioning

confidence: 99%

Arterial pulmonary hypertension in noncardiac intensive care unit

Tsapenko¹

2008

VHRM

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Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Signifi cant pathophysiologic differences between acute and chronic pulmonary hypertension make current classifi cation and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classifi cation of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in combinations with other agents, and must be individualized based on patient response.

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The Effect of Milrinone on the Right Ventriclular Function in Patients with Reduced Right Ventricular Function Undergoing Off-pump Coronary Artery Bypass Graft Surgery

Cited by 18 publications

References 22 publications

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

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

The effect of milrinone on mortality in adult patients: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

Arterial pulmonary hypertension in noncardiac intensive care unit

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