Faculty Collaboration Database

Inhaled Milrinone After Left Ventricular Assist Device Implantation. J Card Fail 2015 Oct;21(10):792-7

Date

05/06/2015

Pubmed ID

25937146

DOI

10.1016/j.cardfail.2015.04.011

Scopus ID

2-s2.0-84942596074 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation.

METHODS AND RESULTS: We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P = .017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively).

CONCLUSIONS: iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.

Author List

Haglund NA, Burdorf A, Jones T, Shostrom V, Um J, Ryan T, Shillcutt S, Fischer P, Cox ZL, Raichlin E, Anderson DR, Lowes BD, Dumitru I

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Administration, Inhalation
Aged
Cost-Benefit Analysis
Female
Heart Failure
Heart Ventricles
Heart-Assist Devices
Hemodynamics
Humans
Male
Middle Aged
Milrinone
Postoperative Care
Treatment Outcome
Vasodilator Agents
Ventricular Dysfunction, Right