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Eur J Cardiothorac Surg 2005;28:425-430
© 2005 Elsevier Science NL

Original articles

Effects of cardiopulmonary bypass on glucose homeostasis after coronary artery bypass surgery

^a Department of Cardiothoracic Surgery and Anaesthesiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden
^b Department of Endocrinology and Diabetology, Karolinska University Hospital, S-171 76 Stockholm, Sweden

Received 13 December 2004; received in revised form 12 May 2005; accepted 18 May 2005.

^* Corresponding author. Tel.: +46 8 5177 7013; fax: +46 8 322 701. (Email: russell.anderson{at}kirurgi.ki.se).

Abstract

Objective: Hyperglycaemia is associated with increased mortality and morbidity after cardiac surgery. While surgical stress results in hyperglycaemia after all operations, it has been suggested that cardiopulmonary bypass is the dominating contributor after cardiac surgery. This study aimed to determine the contribution of cardiopulmonary bypass to hyperglycaemia after coronary artery bypass. Methods: Patients scheduled for primary coronary artery bypass grafting were randomised to surgery with or without cardiopulmonary bypass. All patients received continuous insulin infusions during the initial 24-h period. Glucose was infused (100mg/kg per h) postoperatively in the intensive care unit but not during surgery. Blood glucose was measured 4 times daily until the third postoperative day. Serum insulin, insulin-like growth factor-1 and its binding protein were determined. Results: Average blood glucose during the day of surgery did not differ between groups, but 30% more insulin (P=0.003) was required when cardiopulmonary bypass was used. Blood glucose 2–3h after meals was higher in patients using cardiopulmonary bypass during the first 3 postoperative days. Fasting blood glucose was still equally elevated 20–30% in both groups on the third postoperative day. Insulin-like growth factor-1 decreased more (P=0.01) and insulin-like growth factor binding protein-1 increased more (P<0.001) with cardiopulmonary bypass than without. The ratio of insulin-like growth factor-1 concentration to the concentration of its binding protein-1 was more negative (indicating greater catabolism) with cardiopulmonary bypass than without both postoperatively (P=0.002) and on the third postoperative day (P=0.02). Insulin-like growth factor-1 standard deviation score, also a measure of catabolism, was greater after surgery with cardiopulmonary bypass than without (P=0.02). Conclusions: Glucose homeostasis is disturbed preoperatively for many non-diabetic patients undergoing coronary bypass surgery. Cardiopulmonary bypass exacerbates the catabolism and disturbed glucose homeostasis that is induced also to a lesser degree by surgery without cardiopulmonary bypass.

Key Words: Coronary artery bypass surgery • Off-pump • Cardiopulmonary bypass • Insulin-like growth factor I • Insulin-like growth factor binding proteins • Hyperglycaemia

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