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Review

Three good reasons for heart surgeons to understand cardiac metabolism

Department of Cardiac Surgery, University of Leipzig Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany

Received 26 November 2007; received in revised form 10 February 2008; accepted 11 February 2008.

^_* Corresponding author. Tel.: +49 341 865 1423; fax: +49 341 865 1452. (Email: torsten.doenst{at}med.uni-leipzig.de).

It is the principal goal of cardiac surgeons to improve or reinstate contractile function with, through or after a surgical procedure on the heart. Uninterrupted contractile function of the heart is irrevocably linked to the uninterrupted supply of energy in the form of ATP. Thus, it would appear natural that clinicians interested in myocardial contractile function are interested in the way the heart generates ATP, i.e. the processes generally referred to as energy metabolism. Yet, it may appear that the relevance of energy metabolism in cardiac surgery is limited to the area of cardioplegia, which is a declining research interest. It is the goal of this review to change this trend and to illustrate the role and the therapeutic potential of metabolism and metabolic interventions for management. We present three compelling reasons why cardiac metabolism is of direct, practical interest to the cardiac surgeon and why a better understanding of energy metabolism might indeed result in improved surgical outcomes:

(1) To understand cardioplegic arrest, ischemia and reperfusion, one needs a working knowledge of metabolism;

(2) hyperglycemia is an underestimated and modifiable risk factor;

(3) acute metabolic interventions can be effective in patients undergoing cardiac surgery.

Key Words: Metabolism • Cardiac surgery • Outcomes • Metabolic drugs • Hyperglycemia