Abstract
Phosphodiesterase (PDE) III inhibitors (milrinone, amrinone, olprinone) are widely used in cardiovascular surgery as therapeutic agents for perioperative acute ventricular failure. PDE III inhibitors possess unique characteristics as inodilators, with both positive inotropic and vasodilatory effects. Recent research on PDE III inhibitors has focused on issues of dose, efficacy, and safety. On the basis of recent clinical studies, the new concept of preemptive therapy of PDE III inhibitor has been introduced in cardiovascular surgery. Preemptive therapy of PDE III inhibitor involves the administration of milrinone, amrinone, or olprinone in the early period of extracorporeal circulation during which downregulation of beta-adrenergic receptors, inflammatory responses, and reperfusion injury occur. This therapy reduces the risk of low output syndrome and anaerobic metabolism after extracorporeal circulation and reperfusion, leading to (1) hemodynamic optimization and (2) reasonable balance of oxygen supply and demand. Determination of the safety of PDE III inhibitors should be continued to reduce the risk of side effects that were not recognized in the small clinical studies. The concept of preemptive therapy of PDE III inhibitor may also be useful in the areas of aortic surgery and organ transplantation.
