Effects of Milrinone Versus Epinephrine on Left Ventricular Relaxation After Cardiopulmonary Bypass Following Myocardial Revascularization: Assessment by Color M-Mode and Tissue Doppler

doi:10.1053/j.jvca.2005.03.011

Journal of Cardiothoracic and Vascular Anesthesia

Volume 19, Issue 3, June 2005, Pages 334-339

https://doi.org/10.1053/j.jvca.2005.03.011 Get rights and content

Objective: The purpose of this study was to evaluate the left ventricular lusitropic effects of epinephrine versus milrinone after cardiopulmonary bypass.

Design: Prospective randomized study.

Setting: Single institution, university teaching hospital.

Participants: Adult patients undergoing coronary artery bypass grafting under cardiopulmonary bypass.

Interventions: After separation from cardiopulmonary bypass, patients were randomized to receive intravenous epinephrine by continuous infusion (0.03 μg/kg/min) or milrinone (50 μg/kg followed by 0.5 μg/kg/min). Transesophageal echocardiographic evaluation of left ventricular diastolic function, with emphasis on relaxation, was performed before and after bypass and after the administration of either epinephrine or milrinone.

Measurements and Main Results: Measurements included pulse-wave Doppler analysis of mitral inflow and pulmonary vein and left ventricular outflow tract velocities. Left ventricular inflow velocity of propagation measured with color M-mode and tissue Doppler assessment of early mitral annulus velocity were used to evaluate left ventricular relaxation. Values of velocity of propagation and mitral annulus velocity improved significantly after bypass, suggesting improved relaxation. The administration of either epinephrine or milrinone did not result in further improvement in left ventricular relaxation.

Conclusions: After cardiopulmonary bypass, left ventricular relaxation was significantly improved. Neither epinephrine nor milrinone exhibited favorable lusitropic effects after bypass.

Section snippets

Methods

After approval of the local institutional review board and signed informed consent, 45 patients scheduled for coronary artery bypass grafting were enrolled. Anesthesia was accomplished with sodium thiopental (2–4 mg/kg) or etomidate (0.2–0.3 mg/kg), fentanyl (total dose 20–25 μg/kg), midazolam (total dose 0.05–0.15 mg/kg), and pancuronium (0.1 mg/kg) supplemented with isoflurane and oxygen. Intraoperative monitoring included placement of radial artery and pulmonary artery catheters.

Results

Demographic characteristics were similar among the 3 groups (Table 1), with the exception that there were significantly fewer hypertensive patients on chronic beta-blockade in the epinephrine group (7 of 12 v 11 of 13 in the milrinone group and 11 of 11 controls). Hemodynamic comparisons are shown in Table 2. All groups showed significant increases in heart rate in the post-CPB period. The epinephrine group did not reach statistical significance until after the epinephrine infusion was started.

Discussion

The present results show that there is an improvement in LV relaxation immediately post-CPB, which is unchanged by the administration of either epinephrine or milrinone. On reviewing the most specific echocardiographic indicators of LV relaxation (color M-mode and TDe), the authors noted a return to baseline function early in the post-CPB period by the time of chest closure. The color M-mode plots (Fig 3) show a more dramatic (but not statistically significant) return to baseline in the control

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Original articleEffects of Milrinone Versus Epinephrine on Left Ventricular Relaxation After Cardiopulmonary Bypass Following Myocardial Revascularization: Assessment by Color M-Mode and Tissue Doppler

Section snippets

Methods

Results

Discussion

J Am Coll Cardiol

J Thorac Cardiovasc Surg

J Am Coll Cardiol

J Cardiothorac Vasc Anesth

Br J Anaesth

J Cardiothorac Vasc Anesth

J Thorac Cardiovasc Anesth

J Cardiothorac Vasc

J Cardiothorac Vasc Anesth

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Cardiothorac Vasc Anesth

Original article
Effects of Milrinone Versus Epinephrine on Left Ventricular Relaxation After Cardiopulmonary Bypass Following Myocardial Revascularization: Assessment by Color M-Mode and Tissue Doppler