Abstract 18457: Outpatient Milrinone Therapy as a Bridge to Pediatric Heart Transplantation: A Large Single Center Experience

Abstract

Objective: Milrinone infusion as treatment of end stage heart failure in children is well established. Previous reports of outpatient milrinone therapy (tx) are limited by small numbers. Our objective was to evaluate the safety of outpatient milrinone tx as a bridge to heart transplant (HT). Methods: We retrospectively reviewed the records of all patients (pt) at our institution that have received outpatient milrinone tx between February 2000 and June 2013. Results: A total of 53 pt received outpatient milrinone tx, all had failed milrinone weaning, all began milrinone as an inpatient, and all had an indication of bridge to HT. The median age was 9.7 years [IQR 2-16] and 27 (51%) were male. The diagnosis prior to HT was congenital heart disease (15), cardiomyopathy (21; 16 dilated and 5 restrictive), and graft failure (17). Successful HT was performed in 52 and 1 pt is alive waiting. The median length of stay (LOS) for initiation of milrinone was 7 days (d) [IQR 2-16]. There were 2737 d of outpatient milrinone tx without a death and the median duration of tx was 28 d [IQR 15-62; range1-377]. The mean dose was 0.5 ± 0.02 mcg/kg/min. Arrhythmias occurred in 2 pt (atrial flutter and 3 beats of non-sustained ventricular tachycardia). There were 27 rehospitalizations in 16 pt for a total 97 inpatient days with a median LOS of 2d [IQR 1-3]. Indications for rehospitalization were atrial flutter (1pt, 3d),worsening heart failure (4pt, 26d, median LOS=3d [IQR 1-11]), central venous line (CVL) malfunction (10 pt, 23d, median LOS = 1d [IQR 1-2], CVL infection (2 pt, 5d, mean LOS = 2.5d +/- 0.71, and other (16pt,10 admissions, 40d, median LOS=2d [IQR 1-6]. One pt with worsening heart failure was admitted for additional inotropic support with dopamine and remained an inpatient until HT. Conclusion: There was no mortality in patients on milrinone awaiting HT. Arrhythmias were rare and catheter related complications were infrequent. The outpatient use of milrinone in children is safe and effective when initiated in the inpatient setting and it may reduce costs and improve quality of life in children awaiting HT.