TY - JOUR
T1 - The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times
AU - Assad-Kottner, Christian
AU - Chen, David
AU - Jahanyar, Jama
AU - Cordova, Francisco
AU - Summers, Nathan
AU - Loebe, Matthias
AU - Merla, Ramanna
AU - Youker, Keith
AU - Torre-Amione, Guillermo
PY - 2008/12
Y1 - 2008/12
N2 - Objective: The limited availability of donor organs creates a need for more effective management of heart disease when bridging a patient to cardiac transplant. Inotropic therapy is becoming more commonly used long term to maintain baseline function. The effectiveness and complications associated with their use have not been fully evaluated, and indications for mechanical versus medical therapy as a bridge have not been delineated. Methods and Results: The purpose of this study is to evaluate the safety and efficacy of milrinone as a bridge to transplant. This was a retrospective study of 60 patients listed for a cardiac transplant and committed to home intravenous milrinone therapy. A subgroup of patients who eventually progressed to the use of a ventricular assist device were analyzed. Complications and survivals were analyzed for each group. Forty-six patients (76%) were successfully bridged to transplant with milrinone alone, and 14 patients' (24%) conditions deteriorated and required a left ventricular assist device (LVAD); 1-year survivals were 83% and 71%, respectively. The mean waiting time was 59.5 days (9-257 days) for patients receiving milrinone who did not require an LVAD and 112 days (24-270 days) for those whose conditions deteriorated to require an LVAD. Conclusions: This study suggests that chronic intravenous milrinone provides an adequate strategy as a bridge to transplant if the waiting time is short (<100 days), whereas an elective ventricular assist device implantation may be a safer strategy for patients expected to wait longer. These data provide the basis for a prospective evaluation of inotrope versus LVAD as a bridge to transplantation.
AB - Objective: The limited availability of donor organs creates a need for more effective management of heart disease when bridging a patient to cardiac transplant. Inotropic therapy is becoming more commonly used long term to maintain baseline function. The effectiveness and complications associated with their use have not been fully evaluated, and indications for mechanical versus medical therapy as a bridge have not been delineated. Methods and Results: The purpose of this study is to evaluate the safety and efficacy of milrinone as a bridge to transplant. This was a retrospective study of 60 patients listed for a cardiac transplant and committed to home intravenous milrinone therapy. A subgroup of patients who eventually progressed to the use of a ventricular assist device were analyzed. Complications and survivals were analyzed for each group. Forty-six patients (76%) were successfully bridged to transplant with milrinone alone, and 14 patients' (24%) conditions deteriorated and required a left ventricular assist device (LVAD); 1-year survivals were 83% and 71%, respectively. The mean waiting time was 59.5 days (9-257 days) for patients receiving milrinone who did not require an LVAD and 112 days (24-270 days) for those whose conditions deteriorated to require an LVAD. Conclusions: This study suggests that chronic intravenous milrinone provides an adequate strategy as a bridge to transplant if the waiting time is short (<100 days), whereas an elective ventricular assist device implantation may be a safer strategy for patients expected to wait longer. These data provide the basis for a prospective evaluation of inotrope versus LVAD as a bridge to transplantation.
KW - Assist device
KW - bridge to transplant
KW - left ventricular assist device
KW - milrinone
UR - http://www.scopus.com/inward/record.url?scp=56449093105&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=56449093105&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2008.08.004
DO - 10.1016/j.cardfail.2008.08.004
M3 - Article
C2 - 19041047
AN - SCOPUS:56449093105
SN - 1071-9164
VL - 14
SP - 839
EP - 843
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 10
ER -