oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG
Linköping Univ Hosp, Linköping, Sweden.
Örebro University, School of Health and Medical Sciences.
Linköping Univ Hosp, Linköping, Sweden.
Linköping Univ Hosp, Linköping, Sweden.
2010 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 44, no 1, p. 45-58Article in journal (Refereed) Published
Abstract [en]

Objective: Adverse outcome after CABG is closely related to postoperative heart failure precipitated by ischemia and myocardial infarction. Restrictive use of inotropes is therefore desirable. Patients with preoperative left ventricular dysfunction are a high-risk group in this respect. To reduce myocardial oxygen expenditure we evolved a metabolic strategy for perioperative care.

Design: Observational study on 104 consecutive patients with severe left ventricular dysfunction undergoing CABG. The metabolic strategy implied physiological measures to minimize myocardial oxygen expenditure including restrictive use of inotropes and specific measures such as extended CPB and metabolic support to facilitate myocardial recovery. Hemodynamic state was primarily assessed by mixed venous oxygen saturation (SvO(2)). Follow-up averaged 9.7 +/- 1.4 years.

Results: LVEF was 0.30 +/- 0.05 (range 0.20-0.37) and 3.5 +/- 1.3 vessels were bypassed. Inotropes were used in 6.7% for weaning from CPB. Increase of s-creatinine by >= 50% compared to preoperative values was observed in 2.9%. Logistic EuroSCORE was 8.3% whereas observed 30-day mortality was 1.0%. Crude 5-year survival was 89.4%.

Conclusions: The metabolic strategy allowed restrictive use of inotropes and was associated with encouraging long-term survival. Renal function was well preserved suggesting that SvO(2) served as an adequate marker of circulation. Randomized trials with metabolic support are warranted.

Place, publisher, year, edition, pages
Oslo, Norway: Taylor & Francis , 2010. Vol. 44, no 1, p. 45-58
Keywords [en]
Coronary-artery-bypass, left-ventricular dysfunction, glucose-insulin-potassium, ischemic cardiomyopathy, ejection fraction, cardiac-surgery, myocardial revascularization, cardiopulmonary bypass, follow-up, heart-failure
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-20137DOI: 10.3109/14017430903531008ISI: 000274855600007PubMedID: 20141344Scopus ID: 2-s2.0-76649128076OAI: oai:DiVA.org:oru-20137DiVA, id: diva2:450560
Available from: 2011-10-21 Created: 2011-10-21 Last updated: 2018-04-24Bibliographically approved
In thesis
1. Glutamate for metabolic intervention in coronary surgery: with special reference to the GLUTAMICS-trial
Open this publication in new window or tab >>Glutamate for metabolic intervention in coronary surgery: with special reference to the GLUTAMICS-trial
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Myocardial ischemia is a major cause of postoperative heart failure and adverse outcome in coronary artery bypass graft surgery (CABG). Conventional treatment of postoperative heart failure with inotropic drugs may aggravate underlying ischemic injury. Glutamate has been claimed to increase myocardial tolerance to ischemia and promote metabolic and hemodynamic recovery after ischemia. The aim of this work was to investigate if intravenous glutamate infusion given in association with CABG for acute coronary syndrome can reduce mortality and prevent or mitigate myocardial injury and postoperative heart failure. We also wanted to assess neurological safety issues, as a concern with the use of glutamate is that it may act as an excitotoxin under certain conditions.A metabolic strategy for perioperative care was assessed in an observational study on 104 consecutive patients with severe left ventricular dysfunction undergoing CABG. Based on encouraging clinical results, unsurpassed in the literature, the GLUTAMICS-trial was initiated. 861 patients undergoing CABG for acute coronary syndrome were randomly allocated to blinded intravenous infusion of L-glutamicacid solution or saline. The primary endpoint was a composite of postoperative mortality (≤30 days), perioperative myocardial infarction and left ventric ular heart failure in association with weaning from cardiopulmonary bypass. Secondary endpoints included neurological safety issues, degree of myocardial injury,postoperative hemodynamic state, use of circulatory support and cardiac mortality.The event rate was lower than anticipated and the primary endpoint did not differ significantly between the groups. Regarding secondary endpoints there were significant differences compatible with a beneficial effect of glutamate on post-ischemic myocardial recovery. The putative effect of glutamate infusion was seen in more ischemic patients (CCS class IV) and in patients with evident or anticipated LV-failure on weaning from CPB. No evidence for increased incidence of clinical or subclinical neurological injury was found. In conclusion, intravenous glutamate infusion is safe in the dosages employed and could provide a novel and important way of promoting myocardial recovery after ischemic injury.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 87
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 58
Keywords
myocardial ischemia, coronary artery bypass, cardiac surgery, acute coronary syndrome, glutamate, metabolic intervention, postoperative heart failure, myocardial recovery
National Category
Medical and Health Sciences Clinical Medicine Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-19757 (URN)978-91-7668-824-3 (ISBN)
Public defence
2011-11-11, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-07 Created: 2011-10-07 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Vidlund, Mårten

Search in DiVA

By author/editor
Vidlund, Mårten
By organisation
School of Health and Medical Sciences
In the same journal
Scandinavian Cardiovascular Journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 29 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf