Table 1.

Individualized blood pressure management in the post-cardiac surgery patient. SAM: septal anterior motion; CPB: cardiopulmonary bypass; MAP: mean arterial pressure; HCOM/SAM: hypertrophic obstructive cardiomyopathy/systolic anterior motion; LVOT: left ventricular outflow tract; LVH: left ventricular hypertrophy; SBP: systolic blood pressure; VSD: ventricular septal defect; LVAD: left ventricular assist device; VV vs VA ECMO: venovenous vs venoarterial extracorporeal membrane

A. Decision points for individualized blood pressure targets for post cardiac surgery patients
1. Age
2. Nature of surgery
3. Intraoperative course and intraoperative data
4. Left ventricular versus right ventricular dysfunction
5. Presence or absence of mechanical circulatory support devices
B. Patients who need a higher mean arterial pressure goal to optimize tissue perfusion
1. Right ventricular (RV) failure
2. Post-heart transplant with RV dysfunction
3. Hemodynamic instability on weaning from CPB
4. Air in the coronary arteries post-cardiac surgery needing higher MAP goals during initial few hours postoperatively
5. Patients with long CPB time and cross-clamp time
6. Acute kidney injury identified by low urine output intraoperatively
7. HCOM/SAM needing higher MAP to stent open the LVOT
8. Patient with LVH
9. History of chronic hypertension with shift in cerebral autoregulation
C. Patients who need a lower MAP goal to optimize perfusion
1. Patients with LV dysfunction where a reduction in afterload will help increase cardiac output
2. Post aortic surgery, complex congenital repairs, fistula repairs and VSD repairs where a higher-than-normal SBP/MAP can cause increased tension on critical suture sites and lead to catastrophic bleeding
3. Patients with circulatory support devices LVAD, impella, VV vs VA ECMO where increase in systemic arterial blood pressure can compromise flow through these support devices