Cardiovascular Drugs and Therapy

, Volume 7, Issue 4, pp 671–675 | Cite as

Use of milrinone in cardiac surgical patients

  • Kathleen M. Sherry
  • Timothy J. Locke
Short-Term Inotropic Support—Section 2

Summary

Milrinone is shown in 10 patients to be a valuable pharmacological bridge to heart transplantation; it can stabilize and improve decompensated chronic heart failure (CHF) in cases where the response to beta-agonists is inadequate. One patient who had suffered an acute myocardial infarction with heart failure resistant to vasodilators, beta-agonists, and balloon counterpulsation was stabilized with milrinone for 21 days. He was then maintained on ACE inhibitors until heart transplantation 3 months later. The other nine patients with severe decompensated CHF were stabilized on milrinone for between 11 and 51 days. Seven of them received a donor heart. Two patients died of bacteremic shock and terminal heart failure before a suitable organ could be found (31 and 51 days). All patients were clinically improved within 48 hours of the addition of IV milrinone to their therapy. In 55 patients following cardiac surgery, the efficacy and safety of milrinone in the treatment of low cardiac output states is demonstrated. Milrinone has a useful role in the management of patients with circulatory failure both before and after cardiac surgery, and this paper reviews the relevant current literature.

Key Words

phosphodiesterase III inhibitors milrinone chronic heart failure cardiac surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Feldman AM, Bristow MR. The β-adrenergic pathway in the failing heart: Implications for inotropic therapy.Cardiology 1990;77(Suppl 1):1–32.Google Scholar
  2. 2.
    Katz AM. The myocardium in congestive heart failure.Am J Cardiol 1989;63:12A-16A.Google Scholar
  3. 3.
    Harden TK. Agonist induced desensitization of the beta receptor linked adenylate cyclase.Pharmacol Rev 1983;35:5–31.Google Scholar
  4. 4.
    Strasser RJ, Lefkowitz RJ. Homologous desensitization of beta adrenergic receptor coupled adenylate cyclase.J Biol Chem 1985;260:4561–4564.Google Scholar
  5. 5.
    Feldman MD, Copelas L, Gwathmey JK. Deficient production of cyclic AMP: Pharmacological evidence of an important cause of contractile dysfunction in patients with end stage heart failure.Circulation 1987;75:331–339.Google Scholar
  6. 6.
    Gage J, Rutman H, Lucido D, LeJemtel TH. Additive effects of dobutamine and amrinone on myocardial contractility and ventricular performance in patients with severe heart failure.Circulation 1986;4:367–373.Google Scholar
  7. 7.
    Weber KT, Janicki JS, Jain MC. Chronic heart failure secondary to ischemic or idiopathic cardiomyopathy.Am J Cardiol 1986;58:589–595.Google Scholar
  8. 8.
    O'Connell JB, Gilbert EW, Renlund DG, Bristow MR. Enoximone as a bridge to heart transplantation: The Utah Experience.J Heart Lung Transplant 1991;10:477–481.Google Scholar
  9. 9.
    Cody RJ, Muller FB, Kubo SH, et al. Identification of the direct vasodilator effect of milrinone with an isolated limb preparation in patients with chronic heart failure.Circulation 1986;3:124–129.Google Scholar
  10. 10.
    Watson DM, Sherry KM, Weston GA. Milrinone: A bridge to heart transplant.Anaesthesia 1991;46:285–287.Google Scholar
  11. 11.
    Skoyles JR, Sherry KM, Price C. Intravenous milrinone in patients with severe congestive heart failure awaiting heart transplantation.J Cardiothorac Vasc Anesth 1992;6:222–225.Google Scholar
  12. 12.
    Dubois-Rand JL, Loisance D, Duval AM, et al. Enoximone as a pharmacologic bridge to transplantation.Br J Clin Prac 1988;64:3–79.Google Scholar
  13. 13.
    Deeb GM, Bolling SF, Guynn TP, Nicklas JM. Amrinone versus conventional therapy in patients awaiting cardiac transplantation.Ann Thorac Surg 1989;48:665–669.Google Scholar
  14. 14.
    Unerferth DV, Blandford M, Kate. Tolerance to dobutamine after a 72-hour infusion.Am J Med 1980;69:262–266.Google Scholar
  15. 15.
    Packer M, Carver JR, Rodeheffer RJ, et al. Effect of oral milrinone on mortality in severe chronic heart failure.N Engl J Med 1991;325:1468–1475.Google Scholar
  16. 16.
    Cody RJ. Renal and hormonal effects of phosphodiesterase III inhibition in congestive heart failure.Am J Cardiol 1989;63:31A-34A.Google Scholar
  17. 17.
    Thys DM, Kaplan JA. Cardiovascular physiology: An overview.J Cardiothorac Anesth 1989;3(Suppl 2):2–9.Google Scholar
  18. 18.
    Collucci WS. Observations on the intracoronary administration of milrinone and dobutamine to patients with congestive heart failure.Am J Cardiol 1989;63:17A-22A.Google Scholar
  19. 19.
    Krams R, McFalls E, van der Giessen J, et al. Does milrinone have a direct effect on diastolic function?Am Heart J 1991;121:1951–1955.Google Scholar
  20. 20.
    Feneck RO and The European Milrinone Multicentre Trial Group. Intravenous milrinone following cardiac surgery I. Effects of bolus infusion followed by variable dose maintenance.J Cardiothorac Vasc Anesth 1992;6:554–562.Google Scholar
  21. 21.
    Sonnenblick EH, Grose R, Strain J, et al. Effects of milrinone on left ventricular performance and myocardial contractility in patients with severe heart failure.Circulation 1986;73(Suppl III):162–167.Google Scholar
  22. 22.
    Feneck RO and The European Milrinone Multicentre Trial Group. Intravenous milrinone following cardiac surgery II. Influence of baseline hemodynamics and patient factors on therapeutic response.J Cardiothorac Vasc Anesth 1992;6:563–567.Google Scholar
  23. 23.
    Winzelberg GG, Boucher CA, Pohost GM, et al. Right ventricular function in aortic and mitral valve disease: Relation of gated first-pass radionuclide angiography to clinical and hemodynamic findings.Chest 1981;79:520–528.Google Scholar
  24. 24.
    Grose R, Strain J, Yipintosoi T. Right ventricular function in valvular heart disease: Relation to pulmonary artery pressure.J Am Coll Cardiol 1983;2:225–232.Google Scholar
  25. 25.
    Polak JF, Holman BL, Wynne J, Colucci WS. Right ventricular ejection fraction: An indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease.J Am Coll Cardiol 1983;2:217–224.Google Scholar
  26. 26.
    Mangano DT. Biventricular function after myocardial vascularization in humans: Deterioration and recovery patterns during the first 24 hours.Anesthesiology 1985;62:571–577.Google Scholar
  27. 27.
    Konstam MA, Cohen SR, Salem DN. Effect of amrinone on right ventricular function: Predominance of afterload reduction.Circulation 1986;74:359–366.Google Scholar
  28. 28.
    Hess W. Effects of amrinone on the right side of the heart.J Cardiothorac Vasc Anesth 1989;3(Suppl 2):38–44.Google Scholar
  29. 29.
    Daborn AK, Wright E, Harris MNE, Sherry KM. The haemodynamic effects of milrinone on pulmonary vascular resistance following cardiac surgery.J Cardiothorac Vasc Anesth 992;6(Suppl I):32.Google Scholar
  30. 30.
    Grant BJB, Canty JM. Effect of cardiac output on pulmonary hemodynamics.Resp Physiol 1989;76:313–318.Google Scholar
  31. 31.
    McGregor M, Sniderman A. On pulmonary vascular resistance: The need for more precise definition.Am J Cardiol 1985;55:217–221.Google Scholar

Copyright information

© Kluwer Academic Publishers 1993

Authors and Affiliations

  • Kathleen M. Sherry
    • 1
  • Timothy J. Locke
    • 1
  1. 1.The Northern General HospitalSheffieldUK

Personalised recommendations