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Eur J Cardiothorac Surg 2007;31:1081-1087. doi:10.1016/j.ejcts.2007.02.019
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Preliminary experience with inhaled milrinone in cardiac surgery

^a Research Center, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, Quebec H, Canada
^b Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, Quebec H, Canada
^c Department of Anesthesia, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, Quebec H, Canada
^d Department of Biostatistics, Montreal Heart Institute and Université de Montréal, 5000 Belanger Street, Montreal, Quebec H, Canada

Received 27 September 2006; received in revised form 21 February 2007; accepted 23 February 2007.

^_* Corresponding author. Tel.: +1 514 376 3330x3732; fax: +1 514 376 8784. (Email: denault{at}videotron.ca).

Background: Inhaled administration of milrinone reduces pulmonary artery pressure. Pulmonary hypertension (PH) and right heart failure are associated with difficult separation from cardiopulmonary bypass (CPB). Therefore, inhaled milrinone could facilitate separation from CPB. Objective: To determine the impact and timing of administration of inhaled milrinone. Methods: A retrospective analysis of our experience on high-risk patients receiving inhaled milrinone was conducted to evaluate the postoperative course after administration of the drug. Results: Seventy-three patients received inhaled milrinone from June 2002 to February 2005. Mean age was 64 ± 13 years, with a mean preoperative Parsonnet score of 27 ± 14. Inhaled milrinone (5 mg) was administered before (n = 30) or after (n = 40) CPB, three patients had off-pump procedures and were excluded. CPB time was 145 ± 78 min with cross-clamping times of 91 ± 56 min without any significant difference between groups. Fifty-four patients (74%) had difficult separation from CPB, 14 patients (19%) required an intra-aortic balloon pump and 10 patients (14%) needed emergency reinitiation of CPB for hemodynamic instability. Ten patients died in the perioperative period (13.7%). Patients receiving inhaled milrinone prior to CPB initiation had a lowering pulmonary artery pressure after CPB (p < .01) and had less emergency reinitiation of CPB after weaning (3% vs 23%, p = .02) as compared to those with administration after CPB. No detectable side effects were directly linked to the administration of the drug. Conclusion: In this high-risk cohort, use of inhaled milrinone was well tolerated. Administration before initiation of CPB could help weaning from CPB.

Key Words: Pulmonary hypertension • Milrinone • Cardiopulmonary bypass

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