Valvular Heart Disease
Conditions
Keywords
GIK, valvular heart surgery, lactate
Brief summary
Hyperlactatemia, occuring 10-20% in patients undergoing valvular heart surgery, is known to be associated with hemodynamic instability, organ dysfunction and increased postoperative morbidity and mortality. Glucose-Insulin-Potassium(GIK) has been constantly used as an adjuvant therapy in patients with myocardial infarction or in the patients undergoing valvular heart surgery to reduce the low cardiac output syndrome and mortality. GIK is known to prevent excretion of lactate and to increase the extraction of lactate after reperfusion with various mechanism. In addition, it is also known to decrease ischemic-reperfusion injury of myocardium after CPB, to improve myocardial contractility, insulin resistance and hyperglucemia. As a result, it brings hemodynamic stability and sufficient oxygen supply to the tissue, which might reduce the incidence of hyperlactatemia after valvular heart surgery.
Interventions
DRUG(Glucose-Insulin-Potassium)GIK group
infusion of 0.1 IU/kg/hr of insulin and mixture of 30% dextrose water with 80 mmol/l of potassium in the rate of 0.5 ml/kg/hr through out the surgery
same rate of normal saline
Sponsors
Yonsei University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* patients(20 yr or older) undergoing elective valvular heart surgery under cardiopulmonary bypass(CPB) with more than 2 of following features: 1. congestive heart failure 2. infective endocarditis 3. redo valvular surgery 4. surgery combined with coronary bypass graft 5. multiple valvular surgery 6. expected CPB duration longer than 2 hr 7\> preoperative serum creatinine over 1.4 mg/dl 8\> preoperative hemoglobin level less than 12 mg/dl 9\> left ventricular ejection fraction less than 40%
Exclusion criteria
1. emergency surgery 2. hemodynamic instability before surgery (mean arterial pressure \< 60 mmHg, heart rate \>100 /min 3. need for pharmacological or mechanical assist for hemodynamic stability before surgery 4. baseline blood lactate level more than 2 mmol/l 5. on steroid or NSAID 6. hepatic dysfunction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| perioperative blood lactate level | change of blood lactate level for 10 time points (before induction of anesthesia, immediately after induction of anesthesia, pre-CPB, 15 min after CPB, ACC off, post-CPB, sternum closure, ICU admission, 3 h after ICU admission, POD 1) | Measuring blood lactate level at each time point to compare the efficacy of GIK solution between control and Gik group |
Countries
South Korea
Outcome results
None listed