Enhanced ventricular recovery from high dose glucose, insulin and potassium with cardiopulmonary bypass support prior to cardioplegic arrest.
The concept that a beneficial preconditioning effect in ventricular recovery exists using high dose glucose (0.5 mg/kg), insulin (0.3 unit/kg), and potassium (0.2 mmol/kg) (GIK) with 20 min of normothermic cardiopulmonary bypass support (CPB) prior to 60 min of cardioplegic arrest (CA) was tested using 32 mongrel dogs divided into four subset test groups. Group 1 was given GIK and 20 min of CPB prior to CA, Group 2 was given GIK systemically over 10 min but no CPB prior to CA, Group 3 underwent 20 min of CPB without GIK and Group 4 was the control group with no GIK and no CPB assist. To focus specifically on in vivo ventricular recovery, dP/dT (mmHg/sec), developed pressure (dP) (mmHg), and segmental shortening (SS) (%) were measured prior to CPB, then 15, 30, 60, and 90 min after weaning from CPB, while left atrial pressure was kept constant. The average dP/dT (% recovery) at 60 min in Group 1 was 1,454 (122%) and significantly higher (P < or = 0.05) than Groups 2: 1,189 (99%), 3: 1,027 (79%) and 4: 1,030 (82%). Developed pressure at 90 min (% recovery) in Group 1, 88 (111%) was also better than Groups 3, 74 (86%), and 4, 72 (87%) (P < or = 0.05). Segmental shortening (% recovery) at 30 min was better in Group 1 (94%) than in Groups 2 (59%), 3 (73%) and 4 (68%). We conclude that GIK added to 20 min of CPB support prior to cardioplegic arrest enhances post CPB ventricular recovery and weaning from CPB.
Department of Surgery, Iowa Methodist Medical Center, Des Moines.
H
H
Nishida
R K
RK
Grooters
K C
KC
Thieman
H
H
Soltanzadeh
R F
RF
Schneider
D F
DF
Merkley
D000818:Animals; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D004285:Dogs; D005947:Glucose / Q000494:pharmacology*; D006324:Heart Arrest, Induced / Q000379:methods*; D007328:Insulin / Q000494:pharmacology*; D009200:Myocardial Contraction / Q000187:drug effects*; D011188:Potassium / Q000494:pharmacology*; D014021:Tissue Preservation / Q000379:methods
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium