IMPORTANCE OF PREOPERATIVE MYOCARDIAL GLYCOGEN LEVELS IN HUMAN CARDIAC PRESERVATION - PRELIMINARY-REPORT

  • 1 January 1979
    • journal article
    • research article
    • Vol. 78  (5) , 678-687
Abstract
A total of 117 patients undergoing elective coronary artery bypass were divided into 4 groups according to prebypass myocardial glycogen levels and the use of KCl cardioplegia. Myocardial glycogen levels were enhanced with a preoperative fat loading diet and overnight glucose loading. The control group (n = 27) which had mean cardiac glycogen levels of 750 mg/100 g heart weight and no cardioplegia, had a transmural myocardial infarct rate of 14.4%; 35% had severe atrial arrhythmia, 65% had severe ventricular arrhythmias and 31% had severe vasopressor dependence. The group (n = 30) with low cardiac glycogen (736 mg/100 g) and with KCl cardioplegia had an infarct rate of 6.4%; 6.7% had severe atrial arrhythmias, 18% had severe ventricular arrhythmias and 16.7% had severe vasopressure dependence. The group (n = 26) which had high cardiac glycogen levels (1208 mg/100 g) and no cardioplegia had no myocardial infarctions; 3.8% had severe atrial arrhythmias, 27% had severe ventricular arrhythmias and only 7.8% had severe vasopressor need. The group (n = 34) which had high glycogen levels (1516 mg/100 g) and KCl cardioplegia did best with no myocardial infarctions or no severe atrial arrhythmias; 14% had severe ventricular arrhythmias and 2.81% severe vasopressor need. The lessening of vasopressor dependence and severe atrial and ventricular arrhythmias were significant by .chi.2 contingency tables at P < 0.05 and P < 0.001, respectively. One cardiac-related death each occurred in the 2 groups with low glycogen and none in those with high glycogen levels. Better preoperative cardiac nutrition as represented by enhanced cardiac glycogen helps the heart tolerate anoxic stress whether cardioplegia is utilized or not and is additive to KCl cardioplegia.