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

Objectives: The aim of this study was to investigate whether milrinone infusion improved one-year survival in patients who underwent the Norwood-Sano procedure. Design: A retrospective observational study. Setting: A single-institution university hospital. Participants: Children who underwent the Norwood-Sano procedure from January 2008 to December 2014. Interventions: Patients were categorized into two groups: group E+D, who received routine epinephrine and dopamine infusion, and group M, who received routine milrinone infusion for intra- and postoperative inotropic support. Measurements and Main Results: The primary outcome of this study was one-year survival after the Norwood-Sano procedure. A total of 45 patients were included (group E+D, 22; group M, 23). One-year survival in group M was significantly higher than that in group E+D (95.7% [22/23] v 72.7% [16/22], p = 0.03). A Kaplan-Meier curve also showed that one-year survival in group M was significantly higher than that in group E+D (p = 0.04), from the result of the log-rank test. The number of patients who had any arrhythmias in the intensive care unit (ICU) was significantly lower in group M than in group E+D (21.7% [5/23] v 50% [11/22], p = 0.03). The duration of ICU stay did not have statistical difference between groups (group M 19; interquartile range [IQR], 15-28) v group E+D 19.5 (IQR, 16.3-35.5) days, p = 0.57). Conclusions: Perioperative milrinone infusion improved the mortality after the Norwood-Sano procedure. Potential advantages of milrinone compared with epinephrine are fewer arrhythmias and better systemic perfusion, which could decrease lethal cardiac events in the ICU. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

The study indicated that milrinone infusion improves one-year survival in pediatric patients undergoing the Norwood-Sano procedure compared to routine epinephrine and dopamine infusion. Milrinone also reduces the occurrence of arrhythmias and improves systemic perfusion, potentially decreasing lethal cardiac events in the ICU.