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Benefits of Glucose-Insulin-Potassium Before Mitral Valve Replacement

Bülent Tünerir, MD, Recep Aslan, MD, Serap Iiksoy, MD¹, Ömer Çolak, MD², Yavuz Beogul, MD, Tugrul Kural, MD

Department of Thoracic and Cardiovascular Surgery 1 Department of Pathology 2 Department of Biochemistry Osmangazi University Medical School and Research Hospital Eskiehir, Turkey

For reprint information contact: Bülent Tünerir, MD Hasan Polatkan Bulvari No. 122 D. 19 Eskiehir 26120, Turkey Tel:90 222 225 0606 Fax:90 222 230 6215 Email:utuneri1{at}akbank.com.tr

Of 30 consecutive patients undergoing mitral valve replacement, 15 were randomly assigned to receive pretreatment with glucose-insulin-potassium, while the other 15 received the same volume of normal saline. The characteristics of both groups were similar and all patients were in New York Heart Association functional class III or IV. Papillary muscle samples were obtained at the time of surgery and analyzed for glycogen both biochemically and histochemically. The clinical course was monitored closely during the first 24 hours after surgery. The treated patients had significantly higher glycogen levels (mean, 43 ± 13.54 µmol·g^–1) in their heart muscle samples compared to the controls (mean, 22 ± 10.39 µmol·g^–1). The treated patients required less pharmacological inotropic support and they had fewer ventricular arrhythmias and more favorable cardiac output and systemic vascular resistance. However, there was no difference in postoperative pulmonary capillary wedge pressure or mortality between the 2 groups. It was concluded that pretreatment with glucose-insulin-potassium had a significant myocardial protective effect in patients in advanced functional class undergoing mitral valve replacement.