• Salvatore Sardo, Vincenzo Francesco Tripodi, Filippo Guerzoni, Mario Musu, Andrea Cortegiani, and Gabriele Finco.
• Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy. Electronic address: salvatore.sardo@unica.it.
• J. Cardiothorac. Vasc. Anesth. 2023 Nov 1; 37 (11): 226122712261-2271.

ObjectiveThe authors performed a systematic review to evaluate the effect of pharmacologic therapy on pulmonary hypertension in the perioperative setting of elective cardiac surgery (PROSPERO CRD42023321041).DesignSystematic review of randomized controlled trials with a Bayesian network meta-analysis.SettingThe authors searched biomedical databases for randomized controlled trials on the perioperative use of inodilators and pulmonary vasodilators in adult cardiac surgery, with in-hospital mortality as the primary outcome and duration of ventilation, length of stay in the intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, and change in mean pulmonary artery pressure as secondary outcomes.ParticipantsTwenty-eight studies randomizing 1,879 patients were included.InterventionsCatecholamines and noncatecholamine inodilators, arterial pulmonary vasodilators, vasodilators, or their combination were considered eligible interventions compared with placebo or standard care.Measurements And Main ResultsTen studies reported in-hospital mortality and assigned 855 patients to 12 interventions. Only inhaled prostacyclin use was supported by a statistically discernible improvement in mortality, with a number-needed-to-treat estimate of at least 3.3, but a wide credible interval (relative risk 1.26 × 10-17 - 0.7). Inhaled prostacyclin and nitric oxide were associated with a reduction in intensive care unit stay, and none of the included interventions reached a statistically evident difference compared to usual care or placebo in the other secondary clinical outcomes.ConclusionsInhaled prostacyclin was the only pharmacologic intervention whose use is supported by a statistically discernible improvement in mortality in the perioperative cardiac surgery setting as treatment of pulmonary hypertension. However, available evidence has significant limitations, mainly the low number of events and imprecision.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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