title: Protective effects of tight glucose control during cardiopulmonary bypass on myocardium in adult nondiabetic patients undergoing valve replacement.
abstract: BACKGROUND
  In this study, we aimed to evaluate the protective effect of tight glucose control during cardiopulmonary bypass on myocardium in adult nondiabetic patients undergoing isolated aortic valve replacement in a prospective and randomized trial.
  
  
  METHODS
  Sixty-five adult nondiabetic patients undergoing selective isolated aortic valve replacement were enrolled and randomly assigned to an insulin group (patients received a continuous insulin infusion during surgery; n = 33) or a control group (patients were not administered insulin unless their blood glucose level exceeded 200 mg/dL; n = 32). Cardiac troponin I was assayed preoperatively, and then at 2, 6, 12, 24, and 48 hours after aortic cross-declamping. The pre-, intra-, and postoperative relevant data of all selected patients were analyzed.
  
  
  RESULTS
  Tight glucose control reduced postoperative peak release by 48% for cardiac troponin I compared with the control group (0.48 ± 0.12 vs 0.71 ± 0.17 ng/mL; P < 0.0001). Patients with continuous insulin infusion had lower peak inotropic score during the first postoperative 24 hours and peak level of blood glucose (5.8 ± 2.2 vs 8.2 ± 3.1 μg/kg/min; P < 0.0001; 131.9 ± 23.8 vs 191.1 ± 38.5 mg/dL; P < 0.001, respectively), shorter duration of mechanical ventilation and intensive care unit stay and hospital stay compared with the control group (11.6 ± 2.9 hours vs 14.8 ± 3.5 hours; P = 0.0002; 28.4 ± 7.2 hours vs 36.5 ± 7.8 hours; P < 0.0001; 9.4 ± 3.3 days vs 11.5 ± 4.2 days; P = 0.0283, respectively).
  
  
  CONCLUSIONS
  Tight glucose control during cardiopulmonary bypass might provide myocardial protection in adult nondiabetic patients undergoing isolated aortic valve replacement.
authors.affiliation: Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ji
authors.affiliation: Department of Cardiovascular Surgery of Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: WenJun
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai, China. Electronic address: jiqiang1977@aliyun.com.
authors.forename: YunQing
authors.initials: Y
authors.lastname: Mei
authors.affiliation: Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai, China.
authors.forename: XiSheng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.affiliation: Department of Thoracic Cardiovascular Surgery of Tongji Hospital of Tongji University, Shanghai, China.
authors.forename: JianZhi
authors.initials: J
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001786:Blood Glucose / Q000378:metabolism*; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000097:blood / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose