Original articlePediatric cardiacTight Glycemic Control Protects the Myocardium and Reduces Inflammation in Neonatal Heart Surgery
Section snippets
Patients
This study comprised a predefined subgroup analysis as part of a prospective randomized controlled trial [6]. A subgroup of neonates with transposition of the great arteries (d-TGA) or truncus arteriosus, scheduled for surgical repair, was prospectively and randomly assigned to conventional insulin therapy (CIT) or TGC, initiated at induction of anesthesia and continued throughout surgery and stay in the pediatric (P) ICU. Allocation to treatment groups was done by sealed envelopes. The
Demography and Clinical Outcome
Fourteen neonates were included, 7 in each group. There were no differences between groups in baseline characteristics and CPB variables. Median time to extubation tended to be shorter in the TGC group. There were no significant differences in renal function and duration of stay in PICU and the hospital. There were no early or late deaths. The lower incidence of DSC (29% vs 0%) and need for PM (57% vs 14%) in the first 48 hours in the TGC group was not significant (Table 2).
Glucose and Insulin
In the TGC group BG
Comment
This study demonstrates that intraoperative and postoperative TGC in neonatal CHS protected the myocardium and attenuated the inflammatory response evoked by the surgical procedure, which may favorably affect clinical outcome. This did not appear to be mediated by direct insulin signaling effects, but to effects of preventing hyperglycemia during reperfusion.
Implementing TGC carries the risk of evoking biochemical hypoglycemia. We could not identify any deleterious symptoms of these
References (40)
- et al.
Hyperglycemia after infant cardiac surgery does not adversely impact neurodevelopmental outcome
Ann Thorac Surg
(2007) - et al.
Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study
Lancet
(2009) - et al.
Insulin administered at reoxygenation exerts a cardioprotective effect in myocytes by a possible anti-apoptotic mechanism
J Mol Cell Cardiol
(2000) - et al.
Glucose-insulin potassium in cardiac surgery: a meta-analysis
Ann Thorac Surg
(2004) - et al.
Cardiac troponin I in neonates undergoing the arterial switch operation
Ann Thorac Surg
(2002) - et al.
Myocardial protection during elective coronary artery bypass grafting using high-dose insulin therapy
Ann Thorac Surg
(2007) - et al.
Evaluation of heart fatty acid-binding protein as a rapid indicator for assessment of myocardial damage in pediatric cardiac surgery
J Thorac Cardiovasc Surg
(2004) - et al.
Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery
J Am Coll Cardiol
(2004) - et al.
Alterations in plasma B-type natriuretic peptide levels after repair of congenital heart defects: a potential perioperative marker
J Thorac Cardiovasc Surg
(2006) - et al.
Serum lactate level has prognostic significance after pediatric cardiac surgery
J Cardiothorac Vasc Anesth
(2006)