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Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices

AIMS: We present a single‐centre retrospective experience using oral milrinone in patients with a left ventricular assist device (LVAD) and concurrent refractory right ventricular failure. METHODS AND RESULTS: All patients implanted with LVAD between January 2013 and July 2021 from a high‐volume adv...

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Autores principales: Akhtar, Waqas, Butcher, Charles, Morley‐Smith, Andrew, Riesgo Gil, Fernando, Dar, Owais, Baston, Veronica, Dunning, John, Lyster, Haifa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773711/
https://www.ncbi.nlm.nih.gov/pubmed/35906098
http://dx.doi.org/10.1002/ehf2.14092
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author Akhtar, Waqas
Butcher, Charles
Morley‐Smith, Andrew
Riesgo Gil, Fernando
Dar, Owais
Baston, Veronica
Dunning, John
Lyster, Haifa
author_facet Akhtar, Waqas
Butcher, Charles
Morley‐Smith, Andrew
Riesgo Gil, Fernando
Dar, Owais
Baston, Veronica
Dunning, John
Lyster, Haifa
author_sort Akhtar, Waqas
collection PubMed
description AIMS: We present a single‐centre retrospective experience using oral milrinone in patients with a left ventricular assist device (LVAD) and concurrent refractory right ventricular failure. METHODS AND RESULTS: All patients implanted with LVAD between January 2013 and July 2021 from a high‐volume advanced heart failure service were reviewed. Eight patients were initiated on oral milrinone during this period. Oral milrinone was started 1.5 [inter‐quartile range (IQR) 1–2.3] years after LVAD implantation and continued for 1.2 (IQR 0.5–2.8) years. Therapeutic milrinone levels were achieved (232.2 ± 153.4 ng/mL) with 62.4 ± 18% of time within the therapeutic range. Two patients had adverse events (non‐sustained ventricular tachycardia and ventricular fibrillation effectively treated by internal cardioverter defibrillator) but did not require milrinone discontinuation. Four deaths occurred, one after transplant and three from disease progression determined to be unrelated to oral milrinone use. Three patients continue oral milrinone therapy in the community. There was no significant difference found after the initiation of oral milrinone on any of the physiological measures; however, there were trends in reduction of New York Heart Association class from 3.4 ± 0.5 to 3.0 ± 0.8 (P = 0.08), reduction of right atrial/wedge pressure from 0.9 ± 0.3 to 0.5 ± 0.2 (P = 0.08), and improvement of right ventricular stroke work index from 3.8 ± 2 to 5.8 ± 2.7 (P = 0.16). CONCLUSIONS: Oral milrinone appears safe for long‐term use in the outpatient setting when combined with therapeutic monitoring in this complex medical cohort with limited management options. Further study is needed to ascertain whether this treatment is effective in reducing heart failure symptoms and admissions.
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spelling pubmed-97737112022-12-23 Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices Akhtar, Waqas Butcher, Charles Morley‐Smith, Andrew Riesgo Gil, Fernando Dar, Owais Baston, Veronica Dunning, John Lyster, Haifa ESC Heart Fail Short Communications AIMS: We present a single‐centre retrospective experience using oral milrinone in patients with a left ventricular assist device (LVAD) and concurrent refractory right ventricular failure. METHODS AND RESULTS: All patients implanted with LVAD between January 2013 and July 2021 from a high‐volume advanced heart failure service were reviewed. Eight patients were initiated on oral milrinone during this period. Oral milrinone was started 1.5 [inter‐quartile range (IQR) 1–2.3] years after LVAD implantation and continued for 1.2 (IQR 0.5–2.8) years. Therapeutic milrinone levels were achieved (232.2 ± 153.4 ng/mL) with 62.4 ± 18% of time within the therapeutic range. Two patients had adverse events (non‐sustained ventricular tachycardia and ventricular fibrillation effectively treated by internal cardioverter defibrillator) but did not require milrinone discontinuation. Four deaths occurred, one after transplant and three from disease progression determined to be unrelated to oral milrinone use. Three patients continue oral milrinone therapy in the community. There was no significant difference found after the initiation of oral milrinone on any of the physiological measures; however, there were trends in reduction of New York Heart Association class from 3.4 ± 0.5 to 3.0 ± 0.8 (P = 0.08), reduction of right atrial/wedge pressure from 0.9 ± 0.3 to 0.5 ± 0.2 (P = 0.08), and improvement of right ventricular stroke work index from 3.8 ± 2 to 5.8 ± 2.7 (P = 0.16). CONCLUSIONS: Oral milrinone appears safe for long‐term use in the outpatient setting when combined with therapeutic monitoring in this complex medical cohort with limited management options. Further study is needed to ascertain whether this treatment is effective in reducing heart failure symptoms and admissions. John Wiley and Sons Inc. 2022-07-29 /pmc/articles/PMC9773711/ /pubmed/35906098 http://dx.doi.org/10.1002/ehf2.14092 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Short Communications
Akhtar, Waqas
Butcher, Charles
Morley‐Smith, Andrew
Riesgo Gil, Fernando
Dar, Owais
Baston, Veronica
Dunning, John
Lyster, Haifa
Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title_full Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title_fullStr Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title_full_unstemmed Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title_short Oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
title_sort oral milrinone for management of refractory right ventricular failure in patients with left ventricular assist devices
topic Short Communications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773711/
https://www.ncbi.nlm.nih.gov/pubmed/35906098
http://dx.doi.org/10.1002/ehf2.14092
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