A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG
2010 (English)In: SCANDINAVIAN CARDIOVASCULAR JOURNAL, ISSN 1401-7431, Vol. 44, no 1, 45-58 p.Article in journal (Refereed) Published
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 andgt;= 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
2010. Vol. 44, no 1, 45-58 p.
Left ventricular dysfunction, coronary artery bypass surgery, glutamate, glucose-insulin-potassium, inotropic agents
National CategoryMedical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-54390DOI: 10.3109/14017430903531008ISI: 000274855600007OAI: oai:DiVA.org:liu-54390DiVA: diva2:303549
Rolf Svedjeholm, Marten Vidlund, Ingemar Vanhanen and Erik Hakanson, A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG, 2010, SCANDINAVIAN CARDIOVASCULAR JOURNAL, (44), 1, 45-58.
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