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Ann Thorac Surg 2000;69:1823-1826
© 2000 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Milrinone for long-term pharmacologic support of the status 1 heart transplant candidates

^a Division of Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA

Address reprint requests to Dr Canver, Division of Cardiothoracic Surgery, Albany Medical College, 47 New Scotland Ave, Mail Code 55, Albany, NY 12208–3479
e-mail: canverc{at}mail.amc.edu

Background. We determined the efficacy of long-term therapy with milrinone alone or in combination with inotropic agents in status 1 heart transplant candidates as a pharmacological support until heart transplantation.

Methods. Hemodynamic and biochemical variables were recorded in 29 status 1 men with symptoms of severe congestive heart failure, who received continuous intravenous milrinone alone (group 1, n = 21) or in combination with inotropic agents (group 2, n = 8) while awaiting heart transplantation.

Results. Symptomatic relief was noted in all patients of both groups without any preoperative deaths. One patient (4.8%) of group 1 died on the second day and 1 patient of group 2 died 16.4 months after transplantation. Although pulmonary capillary wedge pressure (group 1, p = 0.021; group 2, p = 0.0002), mean pulmonary artery pressure (group 1, p = 0.051; group 2, p = 0.004), and pulmonary vascular resistance (group 1, p = 0.0026; group 2, p = 0.056) were reduced by 1 hour after the onset of treatment and maintained unchanged until transplantation, the changes in mean pulmonary artery pressure in group 1 and pulmonary vascular resistance in group 2 were statistically insignificant except in the posttransplantation period.

Conclusions. Long-term therapy with milrinone in combination with inotropic agents is safe and effective when only milrinone infusion is inadequate for pharmacologic support in status 1 candidates.

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