The Efficacy of Intravenous Milrinone in Left Ventricular Restoration

Atsushi Yamaguchi, MD, Masashi Tanaka, MD, Kazuhiro Naito, MD, Chieri Kimura, MD, Toshiyuki Kobinata, MD, Homare Okamura, MD, Takashi Ino, MD, and Hideo Adachi, MD

Purpose: The aim of this study was to clarify the efficacy of intravenous milrinone in postoperative care for patients following left ventricular (LV) restoration (LVR).
Methods: Fourteen patients who had ischemic cardiomyopathy with an LV ejection fraction (LVEF) of less than 0.30 and an LV end-systolic volume index of more than 100 ml/m2 underwent coronary artery bypass grafting and concomitant LVR. The patients received perioperative management with continuous infusions of 0.5 µg/kg/min milrinone that were started at the induction of a cardiopulmonary bypass (CPB). The perioperative course and outcome of these patients were retrospectively compared with those of matched LVR patients (n = 14) without milrinone administration during perioperative management.
Results: The preoperative LV end-diastolic pressure (26.3 mmHg vs. 15.4 mmHg) and early diastolic filling velocity/atrial filling velocity ratio (4.1 vs. 2.1) in the milrinone patients were significantly worse than those in the control. Even though the preoperative LV function in each patient demonstrated to be extremely poor, the perioperative hemodynamic variables were stable. The administered doses of dobutamine (4.01 vs. 5.81 µg/kg/min) and epinephrine (0.017 vs. 0.038 µg/kg/min) at the end of CPB were significantly lower in the milrinone patients compared to control.
Conclusion: In those patients who underwent LVR because of ischemic cardiomyopathy, the administration of milrinone achieved safe perioperative management for stable hemodynamics and reduced the postoperative doses of dobutamine and epinephrine. (Ann Thorac Cardiovasc Surg 2009; 15: 233-238)

Key words: left ventricular restoration, coronary artery bypass grafting, cardiopulmonary bypass, inotropic agent

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan

Received May 9, 2008; accepted for publication July 18, 2008
Address reprint requests to Atsushi Yamaguchi, MD: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1–847 Amanuma, Omiya-ku, Saitama 330–8503, Japan.