MILRINONE IN PÆDIATRIC CARDIOPULMONARY BYPASS: A PERFUSION-FOCUSED REVIEW OF PHOSPHODIESTERASE-III INHIBITION, CIRCUIT PRIMING STRATEGIES AND INOTROPIC SUPPORT IN CONGENITAL CARDIAC SURGERY

Congenital cardiac surgery in neonates and infants relies on cardiopulmonary bypass (CPB), which gives the surgeon a motionless and bloodless field but exposes an immature myocardium to ischemia, hypothermia, inflammation and hæmodilution. A predictable fall in cardiac output in the hours after surgery, termed “low cardiac output syndrome” (LCOS), remains one of the main causes of postoperative morbidity. Milrinone, a phosphodiesterase-III (PDE-III) inhibitor, provides inotropy, lusitropy and vasodilation without relying on beta-adrenergic receptors, and it is widely used in pædiatric cardiac surgery. This review describes the mechanism of PDE-III inhibition, summarizes the clinical evidence for prophylactic milrinone, discusses how CPB alters milrinone disposition, and outlines the practical considerations for the perfusionist, including timing of administration, circuit use and renal clearance. Dosing figures are quoted only as reported in the cited studies and are not clinical recommendations