Hemodynamic effects of DBcAMP given at 0.05 to 0.3 mg/kg/min for 30 minutes to patients with low cardiac output less than 2.21/min/m2, to patients on IABP and on dopamine or dobutamine were investigated after open-heart surgery. Hemodynamic improvements were observed in cardiac index from 1.81 +/- 0.3 (mean +/- SD) to 2.56 +/- 0.401/min/m2 (p less than 0.001), stroke index from 20.5 +/- 5.2 to 26.4 +/- 5.2 ml/best/m2 (p less than 0.001). TRP decreased from 1963.8 +/- 682.8 to 1153.9 +/- 449.0 (p less than 0.001). These changes were similar to those of Groups II (3.0 greater than or equal to C1 greater than or equal to 2.21/min/m2) and of Group III (C1 greater than 3.01/min/m2). Increases were also observed in CI from 2.28 +/- 0.67 to 2.96 +/- 0.671/min/m2 (p less than 0.001) and in stroke index from 24.4 +/- 7.2 to 29.5 +/- 6.4 ml/best/m2 (p less than 0.001) and significant decreases were observed in TPR and PVR in patients receiving dopamine or dobutamine. These results strongly suggest the inotropic action of DBcAMP was independent on the beta receptor activity and could be a powerful adjunct in the treatment of low cardiac output patients on whom the dopamine or dobutamine was ineffective.