Abstract
Low cardiac output is often the most critical physiologic abnormality in the cardiac surgery patient. The basic thrust of the surgeon should be to prevent low cardiac output by proper preoperative preparation, excellent anesthesia, precise surgery, meticulous myocardial preservation, and proper postoperative care. However, low cardiac output may exist in spite of proper perioperative care. The determinants of low cardiac output must be understood and the syndrome properly treated to achieve a successful outcome of surgery.
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References
Appelbaum A, Blackstone EH, Kouchoukos NT, Kirklin JW: Afterload reduction and cardiac output in infants early after intracardiac surgery. Am J Cardiol 39: 445,1977.
Armstrong PW, Gold HK, Buckley JM, Willerson JT, Sanders CA: Hemodynamic evaluation of rate augmentation produced by atrial pacing and isoproterenol in the early postooperative phase of cardiac valve surgery. Circulation 44:649,1971.
Benotti JR, Grossman W, Braunwald E, Carabello BA: Effects of amrinone on myocardial energy metabolism and hemodynamics in patients with severe congestive heart failure due to coronary artery disease. Circulation 62:28,1980.
Benotti JR, Grossman W, Braunwald E, Davolos DD, Alousi AA: Hemodynamic assessment of amrinone: a new inotropic agent. N Engl J Med 299:1373,1978.
Benzing G, Helmsworth JA, Schrieber JT, Loggie J, Kaplan S: Nitroprusside after open-heart surgery. Circulation 54:467,1976.
Bixler TJ, Gardner TJ, Donahoo JS, Brawley RK, Potter A, Gott VL: Improved myocardial performance in postoperative cardiac surgical patients with sodium nitroprusside. Ann Thorac Surg 25:444,1978.
Bregman D, Casarella WJ: Percutaneous intraaortic balloon pumping: initial clinical experience. Ann Thorac Surg 29:153,1980.
Buckberg GD, Fixier DE, Archie JP: Experimental subendocardial ischemia in dogs with normal coronary arteries. Circ Res 30:67,1972.
Chatterjee K: Effects of dobutamine on coronary hemodynamics and myocardial energetics. In Chatterjee K (ed): Dobutamine: A Ten-Year Review. New York, NCM Publishers Inc, 1989, pp 49–67.
Colucci WS, Wright RF, Braunwald E: New positive inotropic agents in the treatment of congestive heart failure: mechanisms of action and recent clinical developments. N Engl J Med 314:349,1986.
DiSesa VJ, Gold JP, Shemin RJ, Collins JJ Jr, Cohn LH: Comparison of dopamine and dobutamine in patients requiring postoperative circulatory support. Clin Cardiol 9:253,1986.
Dunkman WB, Leinbach RC, Buckley MJ, Mundth ED, Kantrowitz AR, Austen WG, Sanders CA: Clinical and hemodynamic results of intra-aortic balloon pumping and surgery for cardiogenic shock. Circulation 46:465,1972.
Dupuis J-Y, Bondy R, Cattran C, Nathan HJ, Wynands JE: Amrinone and dobutamine as primary treatment of low cardiac output syndrome following coronary artery surgery: a comparison of their effects on hemodynamics and outcome. J Cardiothorac Vasc Anesth 6:542,1992.
Fowler MB, Alderman EL, Oesterle SN, Derby G, Daughters GT, Stinson EB, Ingels NB, Mitchell RS, Miller DC: Dobutamine and dopamine after cardiac surgery: greater augmentation of myocardial blood flow with dobutamine. Circulation 70(Suppl I):I–103,1984.
Goldstein RA, Passamani ER, Roberts R: A comparison of digoxin and dobutamine in patients with acute infarction and cardiac failure. N Engl J Med 303:846, 1980.
Gueldner TL, Lawrence GH: Intra-aortic balloon assist through cannulation of the ascending aorta. Ann Thorac Surg 19:88,1975.
Hazelrigg SR, Auer JE, Seifert PE: Experience in 100 transthoracic balloon pumps. Ann Thorac Surg 54:528,1992.
Kouchoukos NT, Kirklin JW, Sheppard LC, Roe P: Effect of elevation of left atrial pressure by blood infusion on stroke volume early after cardiac operations. Surg Forum 22:126,1971.
Kouchoukos NT, Sheppard LC, Kirklin JW: Effect of alterations in arterial pressure on cardiac performance early after open intracardiac operations. J Thorac Cardiovasc Surg 64:563,1972.
Krause AH, Bigelow JC Jr, Page S: Transthoracic intra-aortic balloon cannulation to avoid repeat sternotomy for removal. Ann Thorac Surg 21:562,1976.
Kreulen TH, Bove AA, McDonough MT, Sands MJ, Spann JF: The evaluation of left ventricular function in man: a comparison of methods. Circulation 51: 677,1975.
Lappas DG, Ohtaka M, Fahmy NR, Buckley MJ: Systemic and pulmonary effects of nitroprusside during mitral valve replacement in patients with mitral regurgitation. Circulation 58(Suppl I):M8,1978.
Leinbach RC, Buckley MJ, Austen WG, Petschek HE, Kantrowitz AR, Sanders CA: Effects of intra-aortic balloon pumping on coronary flow and metabolism in man. Circulation 43,44(Suppl I):I–77,1971.
Maccioli GA, Lucas WJ, Norfleet EA: The intra-aortic balloon pump: a review. J Cardiothorac Anesth 2:365,1988.
Martin RS, Moncure AC, Buckley MJ, Austen WG, Akins C, Leinback RC: Complications of percutaneous intra-aortic balloon insertion. J Thorac Cardiovasc Surg 85:186,1983.
Mayer JH: Subclavian artery approach for insertion of intra-aortic balloon. J Thorac Surg 76:61,1978.
Miller RR, Awan NA, Joye JA, Maxwell KS, DeMaria AN, Amsterdam EA, Mason DT: Combined dopamine and nitroprusside therapy in congestive heart failure: greater augmentation of cardiac performance by addition of inotropic stimulation to afterload reduction. Circulation 55:881,1977.
Parr FVS, Blackstone EH, Kirklin JW: Cardiac performance and mortality early after intra-cardiac surgery in infants and young children. Circulation 51:867,1975.
Perler BA, McCabe CJ, Abbott WM, Buckley MJ: Vascular complications of intra-aortic balloon counterpulsation. Arch Surg 118:957,1983.
Peterson KL, Uther JB, Shabetai R, Braunwald E: Assessment of left ventricular performance in man. Circulation 47:924,1973.
Phillips PA, Bregman D: Intraoperative application of intra-aortic balloon counterpulsation determined by clinical monitoring of the endocardial viability ratio. Ann Thorac Surg 23:45,1977.
Phillips PA, Marty AT, Miyamoto AM: A clinical method for detecting subendocardial ischemia after cardiopulmonary bypass. J Thorac Cardiovasc Surg 69: 30,1975.
Rackley CE: Quantitative evaluation of left ventricular function by radiographic techniques. Circulation 54:862,1976.
Roberts AJ, Niarchos AP, Subramanian VA, Abel RM, Hoover EL, McCabe JC, Case DB, Laragh JH, Gay WA Jr: Hypertension following coronary artery bypass graft surgery. Comparison of hemodynamic responses to nitroprusside, phentolamine, and converting enzyme inhibitor. Circulation 58(Suppl I):I–43,1977.
Robinson BW, Gelband H, Mas MS: Selective pulmonary and systemic vasodilator effects of amrinone in children: new therapeutic implications. J Am Coll Cardiol 21:1461,1993.
Rosenblum R, Tai AR, Lawson D: Dopamine in man: cardiorenal hemodynamics in normotensive patients with heart disease. J Pharmacol Exp Ther 183:256,1972.
Salomon NW, Plachetka JR, Copeland JG: Comparison of dopamine and dobutamine following coronary artery bypass grafting. Ann Thorac Surg 33:48,1982.
Sethna DH, Gray RJ, Moffitt EA, Bussell JA, Raymond MJ, Conklin CM, Matloff JM: Dobutamine and cardiac oxygen balance in patients following myocardial revascularization. Anesth Analg 61:917,1982.
Steen PA, Tinker JH, Pluth JR, Barnhorst DA, Tarhan S: Efficacy of dopamine, dobutamine, and epinephrine during emergence from cardiopulmonary bypass in man. Circulation 57:378,1978.
Stemple DR, Kleiman JH, Harrison DC: Combined nitroprusside-dopamine therapy in severe chronic congestive heart failure. Dose-related hemodynamic advantages over single drug infusions. Am J Cardiol 42:267,1978.
Stephenson LW, Blackstone EH, Kouchoukos NT: Dopamine vs epinephrine in patients following cardiac surgery: randomized study. Surg Forum 27:727,1976.
Stinson EB, Holloway EL, Derby GC, Copeland JG, Oyer PE, Beuhler DL, Griepp RB: Control of myocardial performance early after open-heart operations by vasodilator treatment. J Thorac Cardiovasc Surg 73:523,1977.
Todd GJ, Bregman D, Voorhees AB, Reemtsma K: Vascular complications associated with percutaneous intra-aortic balloon pumping. Arch Surg 118:963,1983.
Tuttle RR, Mills HL: Dobutamine. Development of a new catecholamine to selectively increase cardiac contractility. Circ Res 36:185,1975.
Van Trigt P, Spray TL, Pasque MK, Peyton RB, Pellom GL, Wechsler AS: The comparative effects of dopamine and dobutamine on ventricular mechanics after coronary artery bypass grafting: a pressure-dimension analysis. Circulation 70(Suppl I):I–112,1984.
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Harlan, B.J., Starr, A., Harwin, F.M., Carpentier, A. (1995). Low Cardiac Output: Pathophysiology and Treatment. In: Manual of Cardiac Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-2474-7_8
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DOI: https://doi.org/10.1007/978-1-4612-2474-7_8
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