The Effect of Milrinone on the Right Ventriclular Function in Patients with Reduced Right Ventricular Function Undergoing Off-pump Coronary Artery Bypass Graft Surgery.
10.3346/jkms.2006.21.5.854
- Author:
Jong Hwa LEE
1
;
Young Jun OH
;
Yon Hee SHIM
;
Yong Woo HONG
;
Gijong YI
;
Young Lan KWAK
Author Information
1. Department of Anesthesiology and Pain Medicine, College of Medicine, Yonsei University, Seoul, Korea. ylkwak@yumc.yonsei.ac.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Milrinone;
Ventricular Function, Right;
Thermodilution;
Coronary Artery Bypass, Off-pump
- MeSH:
Ventricular Function, Right/*drug effects;
Phosphodiesterase Inhibitors/*pharmacology;
Milrinone/*pharmacology;
Middle Aged;
Male;
Humans;
Heart Rate/drug effects;
Female;
Echocardiography, Transesophageal;
*Coronary Artery Bypass, Off-Pump;
Blood Pressure/drug effects;
Aged
- From:Journal of Korean Medical Science
2006;21(5):854-858
- CountryRepublic of Korea
- Language:English
-
Abstract:
This investigation evaluated the effect of continuous milrinone infusion on right ventriclular (RV) function during off-pump coronary artery bypass graft (OPCAB) surgery in patients with reduced RV function. Fifty patients scheduled for OPCAB, with thermodilution RV ejection fraction (RVEF) <35% after anesthesia induction, were randomly allocated to either milrinone (0.5 microgram/kg/min) or control (saline) group. Hemodynamic variables and RV volumetric data measured by thermodilution method were collected as follows: after anesthesia induction (T1); 10 min after heart displacement for obtuse marginal artery anastomosis (T2); after pericardial closure (T3). Cardiac index and heart rate increased and systemic vascular resistance significantly decreased in milrinone group at T2. Initially lower RVEF of milrinone group was eventually comparable to control group after milrinone infusion. RVEF did not significantly change at T2 and T3 in both groups. RV end-diastolic volume in milrinone group consistently decreased from the baseline at T2 and T3. Continuous infusion of milrinone without a bolus demonstrated potentially beneficial effect on cardiac output and RV afterload in patients with reduced RV function during OPCAB. However, aggressive augmentation of intravascular volume seems to be necessary to maximize the effect of the milrinone in these patients.
