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J Thorac Cardiovasc Surg 2001;121:1221-1222
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Insulin cardioplegia for elective coronary bypass surgery

Torsten Doenst, MD, Benjamin E. Ayres, BSc, Friedhelm Beyersdorf, MD

Department of Cardiovascular Surgery
University of Freiburg
Freiburg I Br, Germany

To the Editor:

A recent article by Rao and associatesGo 1 reported an improvement in postoperative hemodynamic parameters in a group of patients who received insulin-enhanced cardioplegic solution during coronary artery bypass grafting. The authors attributed their observations to insulin promoting aerobic metabolism and suggested pyruvate dehydrogenase (PDH) activation as a possible mechanism. However, the authors demonstrated that insulin did not affect PDH activity and that arterial glucose levels were similar in all the groups throughout the experiment. In addition, the presented increase in lactate extraction was small and controversial since groups receiving different concentrations of glucose were combined. Thus, the authors' conclusions are attractive but may not be accurate.

We would like to offer an alternative explanation for their findings based on observations made by us and others. WeGo 2 observed no change in glucose uptake or oxidation in isolated postischemic working rat hearts reperfused with insulin. However, we did see an immediate positive inotropic response. Tune, Mallet, and DowneyGo 3 reported a similar effect in the canine heart. We concluded that insulin has a direct effect on the postischemic myocardium, which is independent of the commonly known effects on myocardial metabolism. Clinically, there is severe insulin resistance postoperatively,Go 4 which is consistent with data reported by Rao and associates.Go 1 In light of the results by these investigators, such an independent mechanism may also be an explanation for their observations.

12/8/114349doi:10.1067/mtc.2001.114349

References

  1. Rao V, Borger MA, Weisel RD, Ivanov J, Christakis GT, Cohen G, et al. Insulin cardioplegia for elective coronary bypass surgery. J Thorac Cardiovasc Surg 2000;119:1176-84.[Abstract/Free Full Text]
  2. Doenst T, Richwine RT, Bray MS, Goodwin GW, Frazier OH, Taegtmeyer H. Insulin improves functional and metabolic recovery of reperfused working rat heart. Ann Thorac Surg 1999;67:1682-8.[Abstract/Free Full Text]
  3. Tune JD, Mallet RT, Downey HF. Insulin improves contractile function during moderate ischemia in canine left ventricle. Am J Physiol 1998;274:H1574-81.[Abstract/Free Full Text]
  4. Svedjeholm R, Hakanson E, Vanhanen I. Rationale for metabolic support with amino acids and glucose-insulin-potassium (GIK) in cardiac surgery. Ann Thorac Surg 1995;59:S15-22.




This Article
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Friedhelm Beyersdorf
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Right arrow Articles by Beyersdorf, F.
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Right arrow Coronary disease
Right arrow Myocardial protection

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