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J Thorac Cardiovasc Surg 2004;127:1436-1441
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Insulin-like growth factor 1 improves the relationship between systemic oxygen consumption and delivery in piglets after cardiopulmonary bypass

^a Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada,
^b Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark,
^c The Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark
^d Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom,
^e Department of Cardiology, Royal Children's Hospital, Melbourne, Australia

Received for publication May 23, 2003; revisions received July 26, 2003; revisions received August 11, 2003; accepted for publication September 18, 2003.

^* Address for reprints: Daniel J. Penny, MD, FRCPI, Department of Cardiology, Royal Children's Hospital, Parkville, Melbourne, Australia 3052
dan.penny{at}rch.org.au

OBJECTIVE: We sought to assess the effects of insulin-like growth factor 1 on the balance between systemic oxygen consumption and oxygen delivery after cardiopulmonary bypass in piglets.

METHODS: Twelve piglets weighing 4.5 to 8.3 kg undergoing hypothermic (28°C) cardiopulmonary bypass for 70 to 120 minutes with 40 minutes of aortic crossclamping were studied before and during the first 6 hours after cardiopulmonary bypass. Oxygen consumption was continuously measured by an indirect calorimeter, Deltatrac II MBM-200 Metabolic Monitor (Datex Division Instrumentarium, Helsinki, Finland). Oxygen delivery and cardiac output were calculated from oxygen consumption and the arterial and mixed venous oxygen contents sampled before and every 30 minutes after cardiopulmonary bypass. Oxygen extraction ratio was derived by the ratio of oxygen consumption to oxygen delivery. Arterial blood lactate was measured before and every 30 minutes after cardiopulmonary bypass. Six animals were randomly assigned to receive an intravenous infusion of insulinlike growth factor 1 at 1.2 mg/h from 1 to 6 hours after cardiopulmonary bypass; the remaining 6 served as a control group.

RESULTS: Relative to the control group, intravenous infusion of insulin-like growth factor 1 significantly reduced oxygen consumption (P = .02) and increased cardiac output (P = .016) and oxygen delivery (P = .049) during the first 6 hours after surgery with hypothermic cardiopulmonary bypass. As a result, oxygen extraction was significantly decreased (P = .012).

CONCLUSIONS: Intravenous infusion of insulin-like growth factor 1 improved oxygen transport by reducing oxygen consumption as well as increasing cardiac output and oxygen delivery during the first 6 hours after cardiopulmonary bypass in piglets. This may have important clinical implications for the care of critically ill children after surgery with cardiopulmonary bypass.

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