• Iratxe Zarragoikoetxea, Rosario Vicente, Azucena Pajares, Paula Carmona, Marta Lopez, Ignacio Moreno, Pilar Argente, Fernando Hornero, Francisco Valera, and Jaume Aguero.
• Hospital Universitari i Politecnic La Fe, Valencia, Spain.
• J. Cardiothorac. Vasc. Anesth. 2020 Jan 1; 34 (1): 87-96.

ObjectiveTo quantify the acute effects of dobutamine in postoperative low cardiac output syndrome (LCOS) using transthoracic echocardiographic, hemodynamic, and blood biomarker monitoring and to assess its association with clinical outcomes.DesignObservational prospective study.SettingSingle university hospital.ParticipantsPatients undergoing elective cardiac surgery.InterventionsNone.Measurements And Main ResultsEchocardiographic parameters, hemodynamic data, and plasma biomarkers were obtained before and early after inotrope initiation. The diagnostic value of transthoracic echocardiographic parameters and their association with clinical outcome were evaluated. Thirty-eight LCOS patients and 12 control patients were included. The left ventricular outflow tract velocity time integral was significantly lower in LCOS patients (11.75 v 19.08 cm; p < 0.001) and showed a marked improvement after dobutamine administration (∼37% increase). Dobutamine improved left and right ventricular function, increased mean arterial pressure and urine output, and lowered lactate levels. The duration of dobutamine support, but not in-hospital mortality, was associated with echocardiographic estimates of cardiac performance early after dobutamine initiation.ConclusionsEarly transthoracic echocardiographic assessment and the acute response to inotropic therapy may provide rapid and highly valuable information in the diagnostic workup and risk evaluation of patients with suspected LCOS after cardiac surgery.Copyright © 2019 Elsevier Inc. All rights reserved.

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