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Title: Tight glycemic control protects the myocardium and reduces inflammation in neonatal heart surgery
Authors: Vlasselaers, Dirk ×
Mesotten, Dieter
Langouche, Lies
Vanhorebeek, Ilse
van den Heuvel, Ingeborg
Milants, Ilse
Wouters, Pieter
Wouters, Patrick
Meyns, Bart
Bjerre, Mette
Hansen, Troels Krarup
Van den Berghe, Greet #
Issue Date: Jul-2010
Publisher: Elsevier Science
Series Title: Annals of Thoracic Surgery vol:90 issue:1 pages:22-30
Abstract: BACKGROUND: Neonatal cardiac surgery evokes hyperglycemia and a systemic inflammatory response. Hyperglycemia is associated with intensified inflammation and adverse outcome in critically ill children and in pediatric cardiac surgery. Recently we demonstrated that tight glycemic control (TGC) reduced morbidity and mortality of critically ill children. Experimental data suggest that insulin protects the myocardium in the setting of ischemia-reperfusion injury, but this benefit could be blunted by coinciding hyperglycemia. We hypothesized that insulin-titrated TGC, initiated prior to myocardial ischemia and reperfusion, protects the myocardium and attenuates the inflammatory response after neonatal cardiac surgery. METHODS: This is a prospective randomized study at a university hospital. Fourteen neonates were randomized to intraoperative and postoperative conventional insulin therapy or TGC. Study endpoints were effects on myocardial damage and function; inflammation, endothelial activation, and clinical outcome parameters. RESULTS: Tight glycemic control significantly reduced circulating levels of cardiac troponin-I (p = 0.009), heart fatty acid-binding protein (p = 0.01), B-type natriuretic peptide (p = 0.002), and the need for vasoactive support (p = 0.008). The TGC suppressed the rise of the proinflammatory cytokines interleukin-6 (p = 0.02) and interleukin-8 (p = 0.05), and reduced the postoperative increase in C-reactive protein (p = 0.04). Myocardial concentrations of Akt, endothelial nitric-oxide synthase, and their phosphorylated forms were not different between groups. CONCLUSIONS: In neonates undergoing cardiac surgery, intraoperative and postoperative TGC protects the myocardium and reduces the inflammatory response. This appears not to be mediated by an early, direct insulin signaling effect, but may rather be due to independent effects of preventing hyperglycemia during reperfusion.
ISSN: 0003-4975
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Intensive Care Medicine
Laboratory for Intensive Care Medicine (-)
Unit for Clinical-Translational Research (-)
Clinical Cardiac Surgery
× corresponding author
# (joint) last author

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