The effect of milrinone infusion on right ventricular function during coronary anastomosis and early outcomes in patients undergoing off-pump coronary artery bypass surgery

Abstract

BackgroundDuring coronary anastomosis in off-pump coronary artery bypass surgery (OPCAB), hemodynamic alternations can be induced by impaired diastolic function of the right ventricle. This study was designed to examine the effect of milrinone on right ventricular function and early outcomes in patients undergoing OPCAB.MethodsForty patients undergoing OPCAB were randomly assigned in a double-blind manner to receive either milrinone (milrinone group, n = 20) or normal saline (control group, n = 20). Hemodynamic variables were measured after pericardiotomy (T1), 5 min after stabilizer application for anastomosis of the left anterior descending coronary artery (LAD, T2), the obtuse marginalis branch (OM, T3), the right coronary artery (RCA, T4), 5 min after sternal closure (T5), and after ICU arrival. The right ventricular ejection fraction (RVEF) and right ventricular volumetric parameters were also measured using the thermodilution technique. For evaluation of early outcomes, the 30-day operative mortality and morbidity risk models were used.ResultsThere was no significant difference in hemodynamic variables, including mean arterial pressure, between the 2 groups, except for the cardiac index and RVEF. The cardiac index and RVEF were significantly greater at T3 in the milrinone group than in the control group.ConclusionsContinuous infusion of milrinone demonstrated a beneficial effect on cardiac output and right ventricular function in patients undergoing OPCAB, especially during anastomosis of the graft to the OM artery, and it had no adverse effect on early outcomes.

The effect of milrinone on mortality in adult patients who underwent CABG surgery: A systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

“…Ultimately, sixteen randomized clinical trials were assessed in compliance with the inclusion criteria ( Table 1). 32,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]…”

The effect of milrinone on mortality in adult patients who underwent CABG surgery: A systematic review of randomized clinical trials with a meta-analysis and trial sequential analysis

“…Of these, the most common reasons for exclusion were as follows: valid data could not be obtained by the authors (87 studies), milrinone was compared with other drugs (17 studies), pediatric populations were used (11 studies), studies were nonrandomized controlled trials (9 studies), crossover studies (5 studies), studies published as abstracts only (4 studies), studies used mechanical devices as controls (4 studies), studies used inhaled milrinone (3 studies), studies used randomization of brain-dead organ donors (3 studies), studies were animal studies (2 studies), and studies used healthy volunteers (1 study). Ultimately, sixteen randomized clinical trials were assessed in compliance with the inclusion criteria (Table 1) [31,[38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

“…The total number of patients in the 16 included trials was 698, who underwent CABG surgery (346 treated with placebo/standard care and 352 treated with milrinone) ( Table 2 and Table 3). In ve of these studies, off-pump CABG surgery was performed [31,41,45,46,49], and on-pump CABG surgery was performed in 11 studies [39-45, 48, 49, 51, 52]. As the result showed, the mortality of on-pump CABG between milrinone treatment and placebo/standard care groups, the occurrence was [5/139 (3.59 %) vs. 4/146 (2.74 %), odds ratio (OR) = 1.17 (0.37-3.72), p value = 0.649, I-squared = 0.0%].…”

The effect of milrinone on mortality in adult patients: A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

“…Ultimately, sixteen randomized clinical trials were assessed in compliance with inclusion ( Table 1). 32,[39][40][41][42][43][44][45][46][47][48][49][50][51][52]…”

“…The total number of patients in16 included trials was 698, undergoing CABG surgery (346 treated with placebo/standard care and 352 treated with milrinone) ( Table 2 and Table 3). Five of these studies performed off-pump CABG 32,42,46,47,50 and 11 performed on-pump CABG surgery. (39-45, 48, 49, 51, 52) Mode of administration included bolus (39-43, 45, 48, 49) , continuous infusion (40)(41)(42)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60) , preceded in 7 studies by an initial bolus, (40-42, 45, 48, 49) which dose varied from 30 to 75 μg/kg in the way of bolus or from 0.25 to 0.75 μg/kg/min as a continuous infusion.…”