Preservation of human cardiac contractility during anoxic arrest with glucose-containing cardioplegia.
Infusing the aortic root with a hypothermic solution containing glucose, insulin, and potassium (GIK) during aortic cross-clamping and anoxic arrest resulted in a significant preservation of human myocardial contractility indices. Control coronary artery surgery patients had acute postcardiopulmonary bypass dp/dtmax depressed to 79.8 per cent prebypass levels and maintained only 73.0 per cent prebypass Vpm. Patients with aortic root GIK maintained 148.1 per cent prebypass dp/dtmax and 157.2 per cent prebypass Vpm, which were significantly better than control (P less than 0.001). These patients also required significantly less vasopressor (P less than 0.05). Patients who maintained at least 85 per cent prebypass dp/dtmax or Vpm had less need for subsequent vasopressor in the recovery period (P less than 0.05). Peak quantitated subsequent vasopressor need had a negative correlation (P less than 0.05) to percentage prebypass Vpm maintained. GIK root infusion enhanced anaerobic metabolism. Coronary washout of acidotic byproducts and direct cardiac buffer combining with improved glycolytic flux and better global hypothermia appeared to be the mechanisms for contractility preservation. Contractility indices appear to be useful in determining subsequent vasopressor needs.
D001011:Aorta; D002315:Cardiopulmonary Bypass; D005260:Female; D005947:Glucose; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007328:Insulin; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011188:Potassium; D011446:Prospective Studies; D011897:Random Allocation; D013696:Temperature
D007328:Insulin; D005947:Glucose; D011188:Potassium