Clinical experience with preoperative myocardial nutrition management

Abstract

Three hundred and twelve elective adult coronary artery surgery patients were divided into five groups differing as to preoperative glucose or fat loading. The control group (n = 54) had a mean myocardial glycogen level of 880 mg/100 gram heart weight, a 18.5% incidence of serious ventricular arrhythmias, 24.2% dependence on vasopressors, a mean peak postoperative SGOT level of 100 IU, and a 3.7% perioperative transmural myocardial infarction rate. The 10% glucose loading group (n = 67) had elevated myocardial glycogen of 1180 mg/100 gram heart, 14.9% serious ventricular arrhythmias but a lessened dependence on vasopressors (17.9%), a peak post bypass SGOT of 74 IU, and 2.9% transmural infarction rate. A 20% glucose overnight loading group (n = 65) had myocardial glycogen level of 1270 mg/100 gram heart, a 23.0% incidence of serious ventricular arrhythmias, a significant reduction in vasopressor dependence (3.1%), no transmural myocardial infarctions, and peak post bypass SGOT of 53 IU. The intravenous fats (10% Intralipid) group (n = 57) had the highest glycogen level of 1509 mg/100 gram heart, the lowest peak SGOT of 51 IU, no infarctions, a low vasopressor dependence (5.2%), but high rate of serious ventricular arrhythmias (22.8%). The oral fat and 20% glucose loading group (n = 69) had a myocardial glycogen of 1486 mg/100 gram heart, a low vasopressor dependence rate of 4.3%, no infarctions, a peak SGOT of 66 IU, and the lowest serious ventricular arrhythmia rate of 4.3%. These results suggest that it is possible to alter prebypass myocardial substrate levels against the stresses of cardiac surgery with fat and/or glucose loading and that myocardial protection is evident.(ABSTRACT TRUNCATED AT 250 WORDS)