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J Thorac Cardiovasc Surg 2000;119:1176-1184
© 2000 The American Association for Thoracic Surgery

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

INSULIN CARDIOPLEGIA FOR ELECTIVE CORONARY BYPASS SURGERY

From The Toronto General Hospital and Sunnybrook Health Science Centre at The University of Toronto, Toronto, Ontario, Canada.

Supported in part by the Heart and Stroke Foundation of Canada (grants NA3767 and NA4189) and the Medical Research Council of Canada (grant MT13513). V.R., M.A.B., and G.C. are Research Fellows of the Heart and Stroke Foundation of Canada. T.M.Y. is a Research Fellow of the Medical Research Council.

Address for reprints: Richard D. Weisel, MD, Chair, Division of Cardiovascular Surgery, EN 14-215, The Toronto Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4.

Background: Improved methods of myocardial preservation are required to reduce the morbidity and mortality of coronary bypass surgery for high-risk subgroups. Metabolic stimulation with insulin, glucose solutions, or both has been proposed as a method to preserve the ischemic myocardium. We performed a prospective, double-blind, randomized trial to evaluate the effects of insulin and glucose as cardioplegic additives when used as part of a tepid continuous blood cardioplegic strategy.
Methods: We randomized 56 male patients undergoing elective isolated coronary bypass surgery to 1 of 4 cardioplegic groups containing either 42 or 84 mmol/L glucose with or without 10 IU/L of insulin. Perioperative assessments of myocardial metabolism and left ventricular function were performed.
Results: Insulin-enhanced cardioplegia was associated with beneficial effects on both myocardial metabolic and functional recovery after cardioplegic arrest. Insulin’s effect was independent of the ambient glucose concentration.
Conclusions: Cardioplegic formulations containing a 42 mmol/L concentration of glucose and a 10 IU/L concentration of insulin provide significant benefit to patients undergoing isolated coronary bypass surgery. The clinical effect of these formulations will need to be assessed in high-risk subgroups of patients, such as those with unstable angina, recent myocardial infarction, or poor left ventricular function.

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