Milrinone Improves Diastolic Function in Coronary Artery Bypass Surgery as Assessed by Acoustic Quantification and Peak Filling Rate: A Prospective Randomized Study

Axelsson, Birger; Arbeus, Mikael; Magnuson, Anders; Hultman, Jan

doi:10.1053/j.jvca.2009.10.007

Cited by 18 publications

(7 citation statements)

References 35 publications

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“…In previous studies on post‐cardiac surgery patients, it was shown that milrinone improved LV systolic function with no beneficial effects on diastolic function, as evaluated by Doppler echocardiography . Axelsson et al, on the other hand, showed that milrinone improved diastolic function when compared to placebo in patients undergoing coronary artery bypass grafting . Our data support the results of Axelsson et al.…”

Section: Discussionsupporting

confidence: 90%

“…The lusitropic effect of inotropic agents has been assessed in several studies with controversial results. Milrinone has been shown to improve diastolic function in patients with congestive heart failure (HF), but data on the lusitropic effect of milrinone in post‐cardiac surgery patients are divergent and inconclusive . Similarly, it has been demonstrated that levosimendan improves diastolic function in patients with acute myocardial infarction and in severe HF .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inotropic and lusitropic effects of levosimendan and milrinone assessed by strain echocardiography—A randomised trial

Fredholm

Jörgensen

Houltz

et al. 2018

Acta Anaesthesiol Scand

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Inotropic and lusitropic effects of levosimendan and milrinone assessed by strain echocardiography—A randomised trial

Fredholm

Jörgensen

Houltz

et al. 2018

Acta Anaesthesiol Scand

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“…21,22 For patients with pulmonary hypertension, pulmonary vasodilators have been shown to improve outcomes. 23,24 For the restrictive LV, milrinone has had mixed results 25,26 whereas close monitoring and optimization of volume status and filling pressures remains the mainstay.…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

et al. 2013

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Background— Although echocardiography is commonly performed before coronary artery bypass surgery, there has yet to be a study examining the incremental prognostic value of a complete echocardiogram. Methods and Results— Patients undergoing isolated coronary artery bypass surgery at 2 hospitals were divided into derivation and validation cohorts. A panel of quantitative echocardiographic parameters was measured. Clinical variables were extracted from the Society of Thoracic Surgeons database. The primary outcome was in-hospital mortality or major morbidity, and the secondary outcome was long-term all-cause mortality. The derivation cohort consisted of 667 patients with a mean age of 67.2±11.1 years and 22.8% females. The following echocardiographic parameters were found to be optimal predictors of mortality or major morbidity: severe diastolic dysfunction, as evidenced by restrictive filling (odds ratio, 2.96; 95% confidence interval, 1.59-5.49), right ventricular dysfunction, as evidenced by fractional area change <35% (odds ratio, 3.03; 95% confidence interval, 1.28-7.20), or myocardial performance index >0.40 (odds ratio, 1.89; 95% confidence interval, 1.13-3.15). These results were confirmed in the validation cohort of 187 patients. When added to the Society of Thoracic Surgeons risk score, the echocardiographic parameters resulted in a net improvement in model discrimination and reclassification with a change in c-statistic from 0.68 to 0.73 and an integrated discrimination improvement of 5.9% (95% confidence interval, 2.8%-8.9%). In the Cox proportional hazards model, right ventricular dysfunction and pulmonary hypertension were independently predictive of mortality over 3.2 years of follow-up. Conclusions— Preoperative echocardiography, in particular right ventricular dysfunction and restrictive left ventricular filling, provides incremental prognostic value in identifying patients at higher risk of mortality or major morbidity after coronary artery bypass surgery.

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“…Yet several studies that have evaluated the lusitropic effect of milrinone in cardiac surgery have showed contradictory results. While milrinone administration after aortic declamping improved the diastolic function as assessed by acoustic quantification and the peak filling rate during coronary artery bypass surgery [16], it failed to demonstrate a favorable lusitropic effect in other studies [25-27]. Many factors might be associated with this controversy; differences in the type of underlying cardiac disease and operation, the varying degrees of preexisting diastolic dysfunction and the modality used to assess diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…When performing OPCAB, the administration of milrinone during the operation reduced the extent of the decrease of the cardiac index and the extent of mitral regurgitation [11-13]. Furthermore, milrinone has been suggested to improve the diastolic function as well as the systolic function [14-16]. Thus, we investigated whether intraoperatively infused milrinone would improve the intraoperative hemodynamics in patients with diastolic dysfunction, as represented by an elevated E/e' value, and who are undergoing OPCAB.…”

Section: Introductionmentioning

confidence: 99%

The effect of milrinone on the intraoperative hemodynamics during off-pump coronary bypass surgery in patients with an elevated echocardiographic index of the ventricular filling pressure

Song

Jun

et al. 2011

Korean J Anesthesiol

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BackgroundHemodynamic derangement during off-pump coronary artery bypass surgery (OPCAB) is mainly attributed to impaired filling and diastolic dysfunction. An elevated ratio of the mitral velocity to the early-diastolic velocity of the mitral annulus (E/e' > 15) is a relatively new indicator of diastolic function, and this was reported to be associated with impaired hemodynamics during OPCAB. We investigated the efficacy of milrinone on the perioperative hemodynamics and short term outcomes of patients with an E/e' > 15 and who underwent OPCAB.MethodsThe patients were randomly allocated into either group C (control, n = 31) or group M (n = 31) and they were treated with the same amount of either normal saline or milrinone (0.5 µg/kg/min) without bolus loading after completion of internal mammary artery harvest until the end of operation. Hemodynamic measurements were recorded after the induction of anesthesia (T1), 5 min after starting each distal anastomosis of the left anterior descending artery (T2), left circumflex artery (T3) and right coronary artery (T4), and 5 min after sternum closure (T5).ResultsThe mixed venous oxygen saturation (SvO2) was lower through T2-T4 compared to the baseline value in both groups, while the degree of the decrease was significantly less in group M than that in group C. The other hemodynamic variables, the operative data and the postoperative outcomes were similar between the two groups.ConclusionsIntraoperative infusion of milrinone did not significantly improve the perioperative hemodynamics and the subsequent short term outcomes for the patients with preexisting diastolic dysfunction as represented by an elevated E/e' value, although it reduced the degree of decrease of the SvO2 during OPCAB.

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Milrinone Improves Diastolic Function in Coronary Artery Bypass Surgery as Assessed by Acoustic Quantification and Peak Filling Rate: A Prospective Randomized Study

Cited by 18 publications

References 35 publications

Inotropic and lusitropic effects of levosimendan and milrinone assessed by strain echocardiography—A randomised trial

Inotropic and lusitropic effects of levosimendan and milrinone assessed by strain echocardiography—A randomised trial

Incremental Value of the Preoperative Echocardiogram to Predict Mortality and Major Morbidity in Coronary Artery Bypass Surgery

The effect of milrinone on the intraoperative hemodynamics during off-pump coronary bypass surgery in patients with an elevated echocardiographic index of the ventricular filling pressure

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