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Ann Thorac Surg 1989;48:484-489
© 1989 The Society of Thoracic Surgeons
Divisions of Cardiology and Cardiovascular Surgery, University of Texas Medical School at Houston, and the Texas Heart Institute, Houston, Texas
* Address reprint requests to Dr Taegtmeyer, Division of Cardiology, University of Texas Medical School at Houston, 6431 Fannin, MSB 1.246, Houston, TX 77030
To assess the effectiveness of metabolic support for the heart in patients with refractory heart failure after hypothermic ischemic arrest for aortocoronary bypass grafting we assigned 22 patients to receive either intravenous glucose (50%), insulin (80 IU/L), and potassium (100 mEq/L) at a rate of 1 mL/kg/h for up to 48 hours (GIK) or glucose (5%) and NaCl (0.225%) at the same rate (control). All patients started out with a mean cardiac index of less than 3.0 L/min/m2, were on intraaortic balloon pump assistance, and required inotropic drugs. At 12 and 24 hours cardiac index had increased significantly in the GIK group when compared with the control group (3.6 and 3.4 versus 2.5 and 2.7 L/min/m2, respectively). Time on the intraaortic balloon pump (39 versus 61 hours) and requirements for inotropic drug support were significantly less in the GIK group than in the control group. All 11 GIK patients could be weaned from intraaortic balloon pump assistance. At 30 days after operation survival was 10/11 in the GIK group, compared with 7/11 in the control group. We conclude that GIK is both safe and effective in the treatment of refractory left ventricular failure after aortocoronary bypass grafting. The exact mechanism for the beneficial effect of GIK on myocardial contractility remains to be elucidated.
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