High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial

•Experimental studies have shown that an increase in blood pressure is likely to improve right ventricular (RV) performance as a result of improvement in right coronary artery blood flow and re-establishment of the transseptal gradient, and thus of RV and left ventricular dimensions.•In the postoper...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2021-10, Vol.35 (10), p.2980-2990
Main Authors: Bootsma, Inge T., de Lange, Fellery, Scheeren, Thomas W.L., Jainandunsing, Jayant S., Boerma, E. Christiaan
Format: Article
Language:English
Subjects:
bloodpressure targets
cardiac surgery
pulmonary artery catheter
right ventricular dysfunction
transesophageal echocardiography
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Summary:•Experimental studies have shown that an increase in blood pressure is likely to improve right ventricular (RV) performance as a result of improvement in right coronary artery blood flow and re-establishment of the transseptal gradient, and thus of RV and left ventricular dimensions.•In the postoperative cardiac surgical patient, norepinephrine-mediated high blood pressure targets did not result in an increase in pulmonary artery catheter derived right ventricular ejection fraction (RVEF), as compared to normal blood pressure targets.•The lack of improvement of RVEF was accompanied by a lack of improvement of regional and global transesophageal-derived measurements.•Mean pulmonary artery pressures increased during norepinephrine administration: a potential positive effect of the rise in blood pressure on RV function was possibly counteracted by an unintended rise in RV afterload.•Not in every clinical setting of RV dysfunction, the application of vasoconstricting approach intended for blood pressure support seems to be the best course of action. Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown. Randomized controlled trial. Single-center study in a tertiary teaching hospital. The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2021.02.054