Milrinone versus Dobutamine as Supportive Agent for Right Ventricular Dysfunction after Cardiopulmonary Bypass: A Randomized Comparative Study.
Mohammed Adel Hegazy, Ibrahim Abdelbaser, Ahmed Abdellatif et al.
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In 30 seconds
This randomized, open-label, parallel-group trial compared milrinone with dobutamine in 88 adults with new right ventricular systolic dysfunction after cardiopulmonary bypass. TAPSE improved over 24 hours in both groups. After adjustment, milrinone was associated with a 1.82 mm higher TAPSE at 24 hours (95% CI 0.72-2.92, p = 0.001), but the clinical importance was uncertain. Overall clinical outcomes were similar, while norepinephrine use was more frequent with milrinone. An exploratory subgroup with elevated pulmonary artery systolic pressure showed greater TAPSE improvement with milrinone.
Key findings
- TAPSE improved significantly over 24 hours in both treatment groups (p < 0.001).
- Adjusted TAPSE at 24 hours was 1.82 mm higher with milrinone (95% CI 0.72-2.92, p = 0.001); clinical significance was uncertain.
- Norepinephrine was required in 93.2% with milrinone versus 72.7% with dobutamine (p = 0.021).
- In the exploratory subgroup with post-CPB PASP >40 mmHg (n = 30), milrinone produced greater TAPSE improvement, with an interaction p = 0.010.
Why it matters
The trial suggests that both agents can support short-term RV functional recovery after bypass, without a demonstrated overall difference in other clinical outcomes. The modest adjusted TAPSE difference with milrinone must be weighed against greater norepinephrine use. The elevated-PASP subgroup result may help frame future research, but does not establish a treatment advantage.
What to keep in mind
The trial was open-label and conducted at a tertiary cardiac surgery center. The TAPSE difference's clinical significance was uncertain, and the elevated-PASP subgroup analysis was exploratory and requires prospective validation.