Perioperative Milrinone Infusion Improves One-Year Survival After the Norwood-Sano Procedure

Study Type: Retrospective observational study of practice change

Methods: Change from adrenaline + dopamine infusion to milrinone infusion as postoperative inotropic support at one centre.

Findings: Milrinone infusion reduced 1 year mortality significantly compared with adrenaline + dopamine.

Commentary: Single centre though it is, this study is conducted at the centre at which Shunji Sano developed the RV-PA shunt that bears his name. In Jan 2011, they changed their standard inotropic plan as above, and the same surgeon did all the operations in the study. No other obvious practice changes occurred. With all the obvious weaknesses such a retrospective design has, the findings are still impressive – 1 year survival goes from 73% to 96%. Accompanying this was a lower rate of arrhythmia and lower maximum lactate levels. Several of the milrinone group ended up on adrenaline as well, and still had better survival.

Any unit not routinely using milrinone in these patients (or routinely using dopamine…) might want to re-evaluate their practice.

Reviewed by Dr Justin Skowno