PMID- 35906098
OWN - NLM
STAT- MEDLINE
DCOM- 20221223
LR  - 20230118
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 9
IP  - 6
DP  - 2022 Dec
TI  - Oral milrinone for management of refractory right ventricular failure in patients 
      with left ventricular assist devices.
PG  - 4340-4343
LID - 10.1002/ehf2.14092 [doi]
AB  - 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.
CI  - (c) 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of European Society of Cardiology.
FAU - Akhtar, Waqas
AU  - Akhtar W
AUID- ORCID: 0000-0001-7563-7346
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Butcher, Charles
AU  - Butcher C
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Morley-Smith, Andrew
AU  - Morley-Smith A
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Riesgo Gil, Fernando
AU  - Riesgo Gil F
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Dar, Owais
AU  - Dar O
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Baston, Veronica
AU  - Baston V
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Dunning, John
AU  - Dunning J
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
FAU - Lyster, Haifa
AU  - Lyster H
AUID- ORCID: 0000-0002-0818-3919
AD  - Department of Advanced Heart Failure, Transplant and Mechanical Support, 
      Harefield Hospital, Hill End Road, Harefield, UB9 6JH, UK.
AD  - King's College London, London, UK.
LA  - eng
PT  - Journal Article
DEP - 20220729
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Humans
MH  - Milrinone/adverse effects
MH  - Retrospective Studies
MH  - *Heart-Assist Devices/adverse effects
MH  - *Heart Failure/therapy/drug therapy
MH  - *Defibrillators, Implantable
PMC - PMC9773711
OTO - NOTNLM
OT  - Inotropes
OT  - LVAD
OT  - Oral milrinone
OT  - Ventricular assist device
COIS- None declared.
EDAT- 2022/07/30 06:00
MHDA- 2022/12/24 06:00
PMCR- 2022/07/29
CRDT- 2022/07/29 21:41
PHST- 2022/07/10 00:00 [revised]
PHST- 2022/03/27 00:00 [received]
PHST- 2022/07/18 00:00 [accepted]
PHST- 2022/07/30 06:00 [pubmed]
PHST- 2022/12/24 06:00 [medline]
PHST- 2022/07/29 21:41 [entrez]
PHST- 2022/07/29 00:00 [pmc-release]
AID - EHF214092 [pii]
AID - 10.1002/ehf2.14092 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2022 Dec;9(6):4340-4343. doi: 10.1002/ehf2.14092. Epub 2022 Jul 
      29.