Inhaled milrinone after left ventricular assist device implantation

Nicholas A. Haglund, Adam Burdorf, Tara Jones, Valerie Shostrom, John Y Um, Timothy Ryan, Sasha K Shillcutt, Patricia Fischer, Zachary L. Cox, Eugenia Raichlin, Brian D Lowes, Ioana Dumitru

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. Methods and Results We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P =.017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). Conclusions iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.

Original languageEnglish (US)
Pages (from-to)792-797
Number of pages6
JournalJournal of Cardiac Failure
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Milrinone
Heart-Assist Devices
Pharmacokinetics
Costs and Cost Analysis
Hypotension
Cardiac Arrhythmias
Hemodynamics
Right Ventricular Dysfunction
Drug Hypersensitivity
Mechanical Ventilators
Ventricular Tachycardia
Arterial Pressure
Hypersensitivity
Nitric Oxide
Therapeutics
Clinical Trials
Lung

Keywords

  • Phosphodiesterase inhibitor
  • left ventricular assist device
  • nebulization
  • right ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Haglund, N. A., Burdorf, A., Jones, T., Shostrom, V., Um, J. Y., Ryan, T., ... Dumitru, I. (2015). Inhaled milrinone after left ventricular assist device implantation. Journal of Cardiac Failure, 21(10), 792-797. https://doi.org/10.1016/j.cardfail.2015.04.011

Inhaled milrinone after left ventricular assist device implantation. / Haglund, Nicholas A.; Burdorf, Adam; Jones, Tara; Shostrom, Valerie; Um, John Y; Ryan, Timothy; Shillcutt, Sasha K; Fischer, Patricia; Cox, Zachary L.; Raichlin, Eugenia; Lowes, Brian D; Dumitru, Ioana.

In: Journal of Cardiac Failure, Vol. 21, No. 10, 01.10.2015, p. 792-797.

Research output: Contribution to journalArticle

Haglund, NA, Burdorf, A, Jones, T, Shostrom, V, Um, JY, Ryan, T, Shillcutt, SK, Fischer, P, Cox, ZL, Raichlin, E, Lowes, BD & Dumitru, I 2015, 'Inhaled milrinone after left ventricular assist device implantation', Journal of Cardiac Failure, vol. 21, no. 10, pp. 792-797. https://doi.org/10.1016/j.cardfail.2015.04.011
Haglund, Nicholas A. ; Burdorf, Adam ; Jones, Tara ; Shostrom, Valerie ; Um, John Y ; Ryan, Timothy ; Shillcutt, Sasha K ; Fischer, Patricia ; Cox, Zachary L. ; Raichlin, Eugenia ; Lowes, Brian D ; Dumitru, Ioana. / Inhaled milrinone after left ventricular assist device implantation. In: Journal of Cardiac Failure. 2015 ; Vol. 21, No. 10. pp. 792-797.
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abstract = "Background Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. Methods and Results We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90{\%} were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30{\%}) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P =.017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). Conclusions iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.",
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AU - Haglund, Nicholas A.

AU - Burdorf, Adam

AU - Jones, Tara

AU - Shostrom, Valerie

AU - Um, John Y

AU - Ryan, Timothy

AU - Shillcutt, Sasha K

AU - Fischer, Patricia

AU - Cox, Zachary L.

AU - Raichlin, Eugenia

AU - Lowes, Brian D

AU - Dumitru, Ioana

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N2 - Background Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. Methods and Results We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P =.017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). Conclusions iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.

AB - Background Proven strategies to reduce right ventricular (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation are lacking. We sought to evaluate the tolerability, feasibility, efficacy, and pharmacokinetics of inhaled milrinone (iMil) delivery after CF-LVAD implantation. Methods and Results We prospectively evaluated fixed-dose nebulized iMil delivered into a ventilator circuit for 24 hours in 10 postoperative CF-LVAD (Heartmate-II) patients. Tolerability (arrhythmias, hypotension, and hypersensitivity reaction), efficacy (hemodynamics), pharmacokinetics (plasma milrinone levels), and cost data were collected.Mean age was 56 ± 9 years, 90% were male, and mean INTERMACS profile was 2.5 ± 0.8. No new atrial arrhythmia events occurred, although 3 (30%) ventricular tachycardia (1 nonsustained, 2 sustained) events occurred. Sustained hypotension, drug hypersensitivity, death, or need for right ventricular assist device were not observed. Invasive mean pulmonary arterial pressure from baseline to during iMil therapy was improved (P =.017). Mean plasma milrinone levels (ng/mL) at baseline, and 1, 4, 8, 12, and 24 hours were 74.2 ± 35.4, 111.3 ± 70.9, 135.9 ± 41.5, 205.0 ± 86.7, 176.8 ± 61.3 187.6 ± 105.5, respectively. Reduced institutional cost was observed when iMil was compared with nitric oxide therapy over 24 hours ($165.29 vs $1,944.00, respectively). Conclusions iMil delivery after CF-LVAD implantation was well tolerated, feasible, and demonstrated favorable hemodynamic, pharmacokinetic, and cost profiles. iMil therapy warrants further study in larger clinical trials.

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