Share This Article:

Single Dose Inamrinone in Terminal Warm Cardioplegia in On-Pump Coronary Artery Bypass Patients

DOI: 10.4236/ojts.2012.21002    3,460 Downloads   5,940 Views  

ABSTRACT

Background: Phosphodiesterase inhibitors (PDI) are used in cardiac surgery to improve and stabilize cardiac function after surgery. The aim of this study is to evaluate changes in hemodynamics and early outcomes when PDI (Inocor/inamrinone) is given in terminal warm blood cardioplegia to on-pump CABG only patients and compare results with patients who did not receive the drug. Material and methods: From April 2003 through September 2004 241 pts underwent elective on-pump CABG only surgery. 141 pts received Inocor in the terminal warm blood cardioplegia (Group 1) and 100 pts did not (Group 2). Results: Demographic data, preoperative EuroSCORE risk scores and operative details were similar. Of pts preoperatively in sinus rhythm (SR) 80.15% in Group 1 and 69.79% in Group 2 regained spontaneous SR (p = 0.07) after release of crossclamp. Inotropic support was needed in 5 pts in Group 1 and in 12 pts in Group 2, p = 0.02. Post cardiopulmonary by-pass (CPB) IABP support was needed for 4 pts in Group 2 and none for Group 1 pts, p = 0.01. There was no operative mortality in either Group and hospital/30 day mortality was similar (3/2.13% vs 3/3.00%, p = 0.69). There were no statistical difference in stay in postoperative intensive care unit (p = 0.15), total hospital stay (p = 0.07), appearance of postoperative atrial fibrillation (p = 0.23) or appearance of postoperative kidney injury (p = 0.27). Post CPB cardiac index improved 16.90% in Group1but decreased 1.49% in Group 2, p < 0.0001. Mean arterial pressure decreased 7.46%in Group 1 pts and 5.08% in Group 2 pts, p = 0.002, but no pts in either Group needed medication for too low blood pressure. Systemic vascular resistance decreased 28.40% in Group 1 and 9.02% in Group 2, p < 0.0001. Conclusions: Inamrinone in terminal warm blood cardioplegia (hot shot) is safe and effective way to improve and stabilize cardiac function after on-pump CABG surgery but does not affect short-term outcomes.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

A. Jyrala, N. M. Gatto and G. L. Kay, "Single Dose Inamrinone in Terminal Warm Cardioplegia in On-Pump Coronary Artery Bypass Patients," Open Journal of Thoracic Surgery, Vol. 2 No. 1, 2012, pp. 5-9. doi: 10.4236/ojts.2012.21002.

References

[1] M. Kikura and S. Sato, “The Efficacy of Preemptive Milrinone or Amrinone Therapy in Patients Undergoing Coronary Artery Bypass Grafting,” Anesthesia & Analgesia, Vol. 94, No. 1, 2002, pp. 22-30.
[2] J.-F. Hardy, N. Searic, M. Roy and J. Perrault, “Amrinone, in Combination with Norepinephrine, Is an Effective First-Line Drug for Difficult Separation from Cardiopulmonary Bypass,” Canadian Journal of Anesthesia, Vol. 40, No. 6, 1993, pp. 495-501.
[3] T. Yamada, J. Takeda, N. Katori, K. Tsuzaki and R. Ochial, “Hemodynamic Effects of Milrinone during Weaning from Cardiopulmonary Bypass: Comparison of Patients with a Low and High Prebypass Cardiac Index,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 14, No. 4, 2000, pp. 367-373. doi:10.1053/jcan.2000.7920
[4] Y. Hamada, K. Kawachi, T. Yamamoto, T. Nakata, Y. Kashu, M. Sato and Y. Watanabe, “Effects of single administration of a phophodiesterase III inhibitor during cardiopulmonary bypass. Comparison of Milrinone and Amrinone,” Japanese Circulation Journal, Vol. 63, No. 8, 1999, pp. 605-6095. doi:10.1253/jcj.63.605
[5] Y. Ko, K. Morita, R. Nagahori, K. Kinouchi, G. Shinohara, H. Kagawa and H. Hashimoto, “Myocardial Cyclic AMP Augmentation with High-Dose PDE III Inhibitor in Terminal Warm Blood Cardioplegia,” Annals of Thoracic and Cardiovascular Surgery, Vol. 15, No. 5, 2009, pp. 311-316.
[6] K. J. Fogg and D. Royston, “Improved Performance with Single Dose Phosphodiesterase Inhibitor (Editorial),” British Journal of Anaesthesia, Vol. 81, No. 5, 1998, pp. 663-666.
[7] M. Kikura, J. H. Levy, J. M. Bailey, J. S. Shanewise, L. G. Michelsen and S. M. Sadel, “A Bolus Dose of 1.5 mg/kg Amrinone Effectively Improves Low Cardiac Output State Following Separation from Cardiopulmonary Bypass in Cardiac Surgical Patients,” Acta Anaesthesiologica Scandinavica, Vol. 42, No. 7, 1998, pp. 825-833. doi:10.1111/j.1399-6576.1998.tb05329.x
[8] J. P. Rathmell, R. C. Prielipp, J. F. Butterworth, E. Williams, F. Villamaria, L. Testa, C. Viscomi, F. P. Ittleman, E. C. Baisden and L. R. Royster, “A Multicenter, Randomized, Blind Comparison of Amrinone with Milrinone after Elective Cardiac Surgery,” Anesthesia & Analgesia, Vol. 86, 1998, pp. 683-690.
[9] P. L. Ludmer, R. F. Wright, J. M. Arnold, P. Ganz, E. Braunwald and W. S. Colucci, “Separation of the Direct Myocardial and Vasodilator Actions of Milrinone Administered by Intracoronary Infusion Technique,” Circulation, Vol. 73, No. 1, 1986, pp. 130-137. doi:10.1161/01.CIR.73.1.130
[10] R. J. Benotti, W. Grossman, E. Braunwald, D. D. Davolos and A. A. Alousi, “Hemodynamic Assessment of Amrinone,” New England Journal of Medicine, Vol. 299, 1978, pp. 1373-1377. doi:10.1056/NEJM197812212992501
[11] K. P. Lewis, I. R. Appadurai, E. T. Pierce, E. F. Halpern and R. H. Bode Jr., “Prophylactic Amrinone for Weaning from Cardiopulmonary Bypass,” Anaesthesia, Vol. 55, No. 7, 2000, pp. 627-633. doi:10.1046/j.1365-2044.2000.01372.x
[12] J. F. Butterworth, R. L. Royster, R. C. Prielipp, S. T. Lawless and S. L. Wallenhaupt, “Amrinone in Cardiac Surgical Patients with Left Ventricular Dysfunction. A Prospective, Randomized Placeo-Controlled Trial,” Chest, Vol. 104, No. 6, 1993, pp. 1660-1667. doi:10.1378/chest.104.6.1660
[13] M. Gillies, R. Bellomo, L. Doolan and B. Buxton, “Bench-to-Bedside Review: Inotropic Drug Therapy after Adult Cardiac Surgery—Systematic Literature Review,” Critical Care, Vol. 9, No. 3, 2005, pp. Se 266-279.
[14] M. Arbeus, B. Axelsson, O. Friberg, A. Magnuson, L. Bodin and J. Hultman, “Milrinone Increases Flow in Coronary Artery Bypass Grafts after Cardiopulmonary Bypass: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 23, No. 1, 2009, pp. 48-53. doi:10.1053/j.jvca.2008.07.005
[15] E. B. Lobato, F. Urdaneta, T. D. Martin and N. Graven- stein, “Effects of Milrinone versus Epinephrine on Grafted Internal Mammary Artery Flow after Cardiopulmonary Bypass,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 14, No. 1, 2000, pp. 9-11. doi:10.1016/S1053-0770(00)90047-8
[16] V. Simkova, P. Radermacher and E. Barth, “Metabolic Effects of phosphodiesterase III Inhibitors: Another Reason to Promote Their Use?” Critical Care, Vol. 11, 2007, pp. 139-140. doi:10.1186/cc5924
[17] M. Jebeli, M. Ghazinoor, M. H. Mandegar, M. R. Rasouli, P. Eghtesadi-Araghi, H. Goodarzynejad, R. Mohaamadzadeh, A. Darehzereshki and S. Dianat, “Effect of Milrinone on Short-Term Outcome of Patients with Myocardial Dysfunction Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial,” Cardiology Journal, Vol. 17, No. 1, 2010, pp. 73-78.
[18] M. Heringlake, M. Wernerus, J. Grünfeld, S. Klaus, H. Heinze, M. Bechtel, L. Bahlmann, J. Poeling and J. Sch?n, “The Metabolic and Renal Effects of Adrenaline and Milrinone in Patients with Myocardial Dysfunction after Coronary Artery Bypass,” Critical Care, Vol. 11, No. 2, 2007, pp. R51-R61. doi:10.1186/cc5904
[19] G. A. Fleming, K. T. Murray, C. Yu, J. G. Byrne, J. P. Greelish, M. R. Petracek, S. J. Hoff, S. K. Ball, N. J. Brown and M. Pretorius, “Milrinone Use Is Associated with Postoperative Atrial Fibrillation after Cardiac Surgery,” Circulation, Vol. 118, No. 16, 2008, pp. 1619-1625. doi:10.1161/CIRCULATIONAHA.108.790162

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.