Long‐term milrinone therapy in children with dilated cardiomyopathy

Abstract

AbstractAimThe aim of this study was to assess the safety and efficacy of long‐term milrinone therapy in children with acute decompensated heart failure due to dilated cardiomyopathy (DCM).MethodsA single‐centre retrospective study of all children ≤18 years with acute decompensated heart failure and DCM who received continuous long‐term (≥7 consecutive days) intravenous milrinone between January 2008 and January 2022.ResultsThe 47 patients had a median age of 3.3 months [interquartile range (IQR) 1.0–18.1], weight of 5.7 kg [IQR 4.3–10.1] and fractional shortening of 11.9% [±4.7]. Idiopathic DCM (n = 19) and myocarditis (n = 18) were the most common diagnoses. The median milrinone infusion duration was 27 days [IQR 10–50, range 7–290]. No adverse events necessitated milrinone termination. Nine patients required mechanical circulatory support. Median follow‐up was 4.2 years [IQR 2.7–8.6]. On initial admission, four patients died, six were transplanted and 79% [37/47] were discharged home. The 18 readmissions resulted in five more deaths and four transplantations. Cardiac function recovered in 60% [28/47], as measured by normalised fractional shortening.ConclusionLong‐term intravenous milrinone is safe and effective in paediatric acute decompensated DCM. Combined with conventional heart failure therapies, it can act as a bridge to recovery and thereby potentially reduce the need for mechanical support or heart transplantation.