Initial Experience of Home Milrinone Therapy in Indian Setup: Case Series

Abstract

<h3>Introduction</h3> Heart failure(HF) is a prevalent issue. Despite maximal oral medical therapy, rapid deterioration is known. Cardiac transplant remains the only definitive therapy. I/v/o limited available organs, patients face prolong waiting periods, clinical deterioration and high mortality. LVADs is not an option in resource-limited settings. Developed nations have used Long-term milrinone therapy in HF patients, but its utility is unexplored in our country. We report 3 cases with end-stage HF who were managed with long term milrinone therapy. One was successfully bridged while the other two are awaiting transplantation <h3>Case Report</h3> 1^st patient:- 37 year C-TGA+IVS +severe systemic AVVR. He presented to us with features of pulmonary oedema, severe systemic ventricular dysfunction and prior 3 episodes of HF requiring hospitalisation. 2^nd patient:-17 year old boy, with DCM in advanced HF. He presented with features of pulmonary oedema, severe systemic ventricular dysfunction, HF ACC stage D with organ dysfunction. 3^rd patient:- 12 year old girl, daughter of a single parent with ischemic cardiomyopathy due to LAD occlusion following MVR for MR(infective endocarditis) 6 months prior. She required ECMO postoperatively and had stormy post-op course(LVEF 45%). She was referred to us with acute HF and LVEF-10%. All were stabilized with non-invasive ventilation, Inj adrenaline, Milrinone and diuretics. Average ICU stay:-7 days. They continued to remain inotrope dependent(INTERMACS-3). They were listed for cardiac transplantation. They were discharged on home Milrinone infusion and anti failure medicines. At home, Milrinone was delivered through PICC line and battery-operated portable infusion pump.Patient-1 received Milrinone for 8 months while other 2 are on it since 4 months. None of them had further episodes of HF. All required PICC line change after 3 months.Patient-1 underwent successful transplantation after 8 months of listing. The other 2 are awaiting transplant <h3>Summary</h3> Utility of long term milrinone in a resource limited country like India is yet to be documented. The overall cost of home milrinone is less than cost of hospitalisation for recurrent HF episodes. Unavailability of home nursing care facility is a drawback. Long term Milrinone therapy is effective and can be safely used as a bridge to transplant. It is cost-effective, improves effort tolerance and reduces HF episodes