• Inge T Bootsma, Fellery de Lange, ScheerenThomas W LTWLDepartment of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Jayant S Jainandunsing, and E Christiaan Boerma.
• Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands. Electronic address: ingebootsma@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2021 Oct 1; 35 (10): 2980-2990.

ObjectiveManagement 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.DesignRandomized controlled trial.SettingSingle-center study in a tertiary teaching hospital.ParticipantsThe 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 <20%, and 34 patients had an RVEF between ≥20% and <30%.InterventionsPatients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period.Measurements And Main ResultsThere was no significant between-group difference in change of RVEF <20% (-1% [-3.3 to 1.8] in the normal-target group v 0.5% [-1 to 4] in the high-target group; p = 0.159). There was no significant between-group difference in change in RVEF 20%-to-30% (-1% [-3 to 0] in the normal-target group v 1% [-1 to 3] in the high-target group; p = 0.074). These results were in line with the simultaneous observation that echocardiographic variables of RV and left ventricular function also remained unaltered over time, irrespective of either baseline RVEF or treatment protocol.ConclusionIn a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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