Milrinone versus Dobutamine as Supportive Agent for Right Ventricular Dysfunction after Cardiopulmonary Bypass: A Randomized Comparative Study

doi:10.1053/j.jvca.2026.07.015

Milrinone versus Dobutamine as Supportive Agent for Right Ventricular Dysfunction after Cardiopulmonary Bypass: A Randomized Comparative Study

J Cardiothorac Vasc AnesthPublished 7 Jul 2026Randomised controlled trial

Primary result · TAPSE at 24 hours (adjusted for baseline TAPSE and LVEF)ResultAdjusted difference 1.82 mm 95% CI 0.72–2.92

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Authors' conclusion

Milrinone and dobutamine provide comparable overall RV recovery, though milrinone was associated with modestly higher adjusted TAPSE at 24 hours of uncertain clinical significance and increased norepinephrine requirements.

Study context

Population: Adults with new right ventricular (RV) systolic dysfunction (TAPSE ≤17 mm) after cardiopulmonary bypass (CPB), tertiary cardiac surgery center
Participants: 88 adults

Comparison: Milrinone vs dobutamine
Primary endpoint: Co-primary: duration of mechanical ventilation and change in TAPSE
Follow-up: 24 hours

Methodological detailsopen-label, parallel-group, single-centre

Open-label
Parallel-group
Single-centre

Primary result

As reported in the abstract

TAPSE at 24 hours (adjusted for baseline TAPSE and LVEF)

Adjusted difference

1.82 mm

95% CI 0.72–2.92

P = 0.001

Milrinone vs Dobutamine

adjusted difference 1.82 mm (95% CI 0.72–2.92); P = 0.001

TAPSE improved significantly over 24 hours in both groups: P < 0.001

Secondary outcomes

TAPSE improvement, subgroup pulmonary artery systolic pressure (PASP) >40 mmHg (n = 30; exploratory) · 1, 6 and 24 hours

Greater TAPSE improvement with milrinone at each time point: P < 0.05

Interaction p = 0.010
Exploratory subgroup analysis

TAPSE, subgroup PASP ≤40 mmHg (n = 58)

Drugs equivalent

Safety

Norepinephrine requirement

P = 0.021

Milrinone93.2%

Dobutamine72.7%

Norepinephrine requirement, subgroup PASP >40 mmHg

P = 0.586

Milrinone93.8%

Dobutamine85.7%

Original publication

Milrinone versus Dobutamine as Supportive Agent for Right Ventricular Dysfunction after Cardiopulmonary Bypass: A Randomized Comparative Study. J Cardiothorac Vasc Anesth. Published 7 July 2026. doi:10.1053/j.jvca.2026.07.015

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