Home Milrinone Therapy for Paediatric Advanced Heart Failure Patients: A Canadian Single-Centre Experience

Abstract

Background

End-stage heart failure (ESHF) is the primary reason for heart transplantation in children with cardiomyopathy. Despite optimizing oral heart failure (HF) medications, some paediatric patients progress to ESHF, necessitating mechanical circulatory support and/or transplantation. Continuous milrinone intravenous support has been used to bridge paediatric patients to transplant. This study aimed to review and report the safety and outcomes of our home milrinone therapy (HMT) programme.

Methods

This single-centre, retrospective cohort study included paediatric patients discharged on HMT between 2001 and 2022. Data were collected from the SickKids HF Database. Outcomes of interest included frequency and indications for rehospitalization, catheter-related complications, and outcomes at the conclusion of therapy.

Results

Thirty-six patients were included, with a median age of 3.6 years and a median weight of 13.1 kg at HMT initiation. HMT was used as a bridge to transplantation (58%) recovery/candidacy (22%), palliative care (17%), and surgical repair (3%). The median duration on HMT was 88 days. Twenty-four patients (67%) were readmitted at least once with a total of 70 admissions, primarily due to central line-related issues (35%) and worsening HF (32%). Among patients discharged as a bridge to transplant, 52% were admitted from home for transplant, whereas 33% required readmission until transplant. No deaths were directly related to HMT.

Conclusions

HMT is a safe and effective method for supporting children with ESHF. This therapy allows children to return to their home environment.