{"id":"ceb66c4b893f","type":"article","url":"https://hartvaat.nl/2018/04/24/hoge-versus-lage-bloeddrukstreefwaarden-tijdens-cardiopulmonale-bypass-en-cerebr/","title":"Hoge versus lage bloeddrukstreefwaarden tijdens cardiopulmonale bypass en cerebraal letsel","title_en":"High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["coronaire-bypass"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030308","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030308","authors":["Anne G Vedel","Frederik Holmgaard","Lars S Rasmussen","Annika Langkilde","Olaf B Paulson","Theis Lange","Carsten Thomsen","Peter Skov Olsen","Hanne Berg Ravn","Jens C Nilsson"],"significance":6,"published":"2018-04-24","source_date":"2018-04-24","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This randomized trial compared high versus low blood pressure targets during cardiopulmonary bypass for prevention of cerebral injury in cardiac surgery, addressing the optimal hemodynamic management during on-pump procedures.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar optimale bloeddrukstreefwaarden tijdens cardiopulmonale bypass voor preventie van cerebraal letsel bij hartchirurgie.","abstract_original":"BACKGROUND: Cerebral injury is an important complication after cardiac surgery with the use of cardiopulmonary bypass. The rate of overt stroke after cardiac surgery is 1% to 2%, whereas silent strokes, detected by diffusion-weighted magnetic resonance imaging, are found in up to 50% of patients. It is unclear whether a higher versus a lower blood pressure during cardiopulmonary bypass reduces cerebral infarction in these patients. METHODS: In a patient- and assessor-blinded randomized trial, we allocated patients to a higher (70-80 mm Hg) or lower (40-50 mm Hg) target for mean arterial pressure by the titration of norepinephrine during cardiopulmonary bypass. Pump flow was fixed at 2.4 L·min-1·m-2. The primary outcome was the total volume of new ischemic cerebral lesions (summed in millimeters cubed), expressed as the difference between diffusion-weighted imaging conducted preoperatively and again postoperatively between days 3 and 6. Secondary outcomes included diffusion-weighted imaging-evaluated total number of new ischemic lesions. RESULTS: Among the 197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4 (8.9) years in the high-target group (n=98). Procedural risk scores were comparable between groups. Overall, diffusion-weighted imaging revealed new cerebral lesions in 52.8% of patients in the low-target group versus 55.7% in the high-target group (P=0.76). The primary outcome of volume of new cerebral lesions was comparable between groups, 25 mm3 (interquartile range, 0-118 mm3; range, 0-25 261 mm3) in the low-target group versus 29 mm3 (interquartile range, 0-143 mm3; range, 0-22 116 mm3) in the high-target group (median difference estimate, 0; 95% confidence interval, -25 to 0.028; P=0.99), as was the secondary outcome of number of new lesions (1 [interquartile range, 0-2; range, 0-24] versus 1 [interquartile range, 0-2; range, 0-29] respectively; median difference estimate, 0; 95% confidence interval, 0-0; P=0.71). No significant difference was observed in frequency of severe adverse events. CONCLUSIONS: Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower mean arterial pressure during cardiopulmonary bypass did not seem to affect the volume or number of new cerebral infarcts. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02185885."}