Long-term milrinone therapy in children with dilated cardiomyopathy

Area of Science:

• Pediatric Cardiology
• Cardiovascular Pharmacology
• Critical Care Medicine

Background:

• Acute decompensated heart failure (ADHF) in children with dilated cardiomyopathy (DCM) presents significant management challenges.
• Long-term intravenous inotropic support is often necessary but requires careful safety and efficacy assessment.

Purpose of the Study:

• To evaluate the safety and efficacy of continuous, long-term intravenous milrinone in pediatric patients with ADHF secondary to DCM.
• To assess milrinone's impact on cardiac function recovery and its role in bridging patients to recovery or transplantation.

Main Methods:

• A retrospective study was conducted on pediatric patients (≤18 years) with ADHF and DCM who received continuous intravenous milrinone for at least 7 days.
• Data collected included patient demographics, diagnoses, milrinone infusion duration, adverse events, need for mechanical support, and clinical outcomes including recovery, transplantation, and mortality.

Main Results:

• Forty-seven patients with a median age of 3.3 months received milrinone for a median of 27 days. Idiopathic DCM and myocarditis were the most common etiologies.
• No adverse events required milrinone discontinuation. Cardiac function normalized in 60% of patients. Initial mortality was 8.5%, with 12.8% undergoing transplantation.
• Readmissions led to additional deaths and transplantations, highlighting the critical nature of ADHF in this population.

Conclusions:

• Long-term intravenous milrinone administration is a safe and effective therapeutic option for pediatric patients experiencing acute decompensated dilated cardiomyopathy.
• Milrinone therapy, when used adjunctively with standard heart failure treatments, can serve as a crucial bridge to cardiac recovery, potentially mitigating the necessity for mechanical circulatory support or heart transplantation.