The Annals of Thoracic Surgery, Vol 38, 37-41, Copyright © 1984 by The Society of Thoracic Surgeons
Comparison of dopamine and dobutamine therapy during intraaortic balloon pumping for the treatment of postcardiotomy low-output syndrome
RP Sterling, H Taegtmeyer, SA Turner, WE Walker and DA Cooley
Treatment of postcardiotomy low-output syndrome includes intraaortic
balloon pumping (IABP), volume loading, pharmacological afterload
reduction, and stimulation with an inotropic agent. This study compares the
effectiveness of combined nitroprusside and dopamine therapy and
nitroprusside and dobutamine therapy in 12 patients requiring IABP
postoperatively. Serial hemodynamic measurements were made before and
during infusion of nitroprusside and after administration of the combined
therapy (N = 6 in each group). Prior to pharmacological therapy, cardiac
index was 1.47 +/- 0.31 L/min/m2 and systemic vascular resistance (SVR) was
3,114 +/- 1,350 dynes sec cm-5 in patients subsequently given dopamine, and
1.59 +/- 0.38 L/min/m2 and 2,661 +/- 405 dynes sec cm-5, respectively, in
those given dobutamine. With infusion of nitroprusside, both groups showed
significant reduction in SVR. Nitroprusside plus either inotropic agent
resulted in augmentation of cardiac index and an additional reduction in
SVR, both changes being greater in the group given dopamine. Larger doses
of dobutamine than dopamine were needed to achieve similar hemodynamic
improvement. We conclude that the addition of an inotropic agent to
vasodilator therapy during IABP results in a greater increase in cardiac
index and a greater decrease in afterload than a vasodilator alone. In
addition to its beneficial effect on renal perfusion at the dose required
to effect these improvements, dopamine appears a better inotropic agent
than dobutamine for postcardiotomy low-output syndrome.
