The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times

Christian Assad-Kottner, David Chen, Jama Jahanyar, Francisco Cordova, Nathan Summers, Matthias Loebe, Ramanna Merla, Keith Youker, Guillermo Torre-Amione

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)839-843
Number of pages5
JournalJournal of Cardiac Failure
Volume14
Issue number10
DOIs
StatePublished - Dec 2008
Externally publishedYes

Fingerprint

Milrinone
Heart-Assist Devices
Transplants
Therapeutics
Survival
Heart Diseases
Retrospective Studies
Transplantation
Tissue Donors
Safety

Keywords

  • Assist device
  • bridge to transplant
  • left ventricular assist device
  • milrinone

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times. / Assad-Kottner, Christian; Chen, David; Jahanyar, Jama; Cordova, Francisco; Summers, Nathan; Loebe, Matthias; Merla, Ramanna; Youker, Keith; Torre-Amione, Guillermo.

In: Journal of Cardiac Failure, Vol. 14, No. 10, 12.2008, p. 839-843.

Research output: Contribution to journalArticle

Assad-Kottner, C, Chen, D, Jahanyar, J, Cordova, F, Summers, N, Loebe, M, Merla, R, Youker, K & Torre-Amione, G 2008, 'The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times', Journal of Cardiac Failure, vol. 14, no. 10, pp. 839-843. https://doi.org/10.1016/j.cardfail.2008.08.004
Assad-Kottner, Christian ; Chen, David ; Jahanyar, Jama ; Cordova, Francisco ; Summers, Nathan ; Loebe, Matthias ; Merla, Ramanna ; Youker, Keith ; Torre-Amione, Guillermo. / The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times. In: Journal of Cardiac Failure. 2008 ; Vol. 14, No. 10. pp. 839-843.
@article{4c6f0d727fd34c53802886ff70331a75,
title = "The Use of Continuous Milrinone Therapy as Bridge to Transplant Is Safe in Patients With Short Waiting Times",
abstract = "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.",
keywords = "Assist device, bridge to transplant, left ventricular assist device, milrinone",
author = "Christian Assad-Kottner and David Chen and Jama Jahanyar and Francisco Cordova and Nathan Summers and Matthias Loebe and Ramanna Merla and Keith Youker and Guillermo Torre-Amione",
year = "2008",
month = "12",
doi = "10.1016/j.cardfail.2008.08.004",
language = "English (US)",
volume = "14",
pages = "839--843",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "10",

}

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

VL - 14

SP - 839

EP - 843

JO - Journal of Cardiac Failure

JF - Journal of Cardiac Failure

SN - 1071-9164

IS - 10

ER -