Artificial endocrine pancreas with a closed-loop system effectively suppresses the accelerated hyperglycemic status afte
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ORIGINAL ARTICLE
Artificial endocrine pancreas with a closed‑loop system effectively suppresses the accelerated hyperglycemic status after reperfusion during aortic surgery Kei Aizawa1 · Arata Muraoka1 · Soki Kurumisawa1 · Hirohiko Akutsu1 · Akira Sugaya1 · Satoshi Uesugi1 · Koji Kawahito1 Received: 23 April 2020 / Accepted: 16 June 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives To control intraoperative hyperglycemia in patients who underwent aortic surgery using STG-55® artificial endocrine pancreas and clarify the effectiveness of this device. Methods Blood glucose control using the STG-55® was performed in 18 patients (15 men and 3 women; age, 66 ± 10 years) who required hypothermic circulatory arrest (STG-55® group). Seventeen patients (10 men and 7 women; age, 71 ± 8 years) whose blood glucose was controlled using the conventional method were included in the control group. Glucose concentration was controlled with the aim of maintaining it at 150 mg/dl. Results In both groups, the blood glucose concentrations did not significantly change during the interruption of systemic perfusion; however, a sharp increase was noted immediately after reperfusion. Although the hyperglycemic status persisted after reperfusion in the control group, it was effectively suppressed in the STG-55® group ( STG® vs. control group at 50 min after reperfusion: 180 ± 35 vs. 212 ± 47 mg/dl, p = 0.026) and blood glucose concentration reached the target value of 150 mg/ dl at 100 min after reperfusion (STG® vs. control group: 153 ± 29 vs. 215 ± 43 mg/dl, p = 0.0008). The total administered insulin dose was 175 ± 81 U and 5 ± 3 U in the STG® and control groups, respectively (p 0.99 0.51 0.44 0.31
7 11
2 15
3
2
5 1 3 0 3 473 ± 106 235 ± 54
0 0 0 1 0 446 ± 99 254 ± 55
0.23 0.28 0.32
47 ± 16
56 ± 15
0.07
0.07
0.11
urgent), and artificial pancreas was used only when the manpower was enough even in the elective cases. The preoperative patient characteristics are described in Table 1.
Methods Surgical procedures Surgery was performed with median sternotomy. Standard cardiopulmonary bypass was established with ascending aorta, axillary artery, and/or femoral artery cannulation and right atrium drainage. A left ventricular venting was inserted through the upper pulmonary vein. Myocardial protection was performed with an antegrade or retrograde infusion of a cold blood cardioplegic solution. All patients required hypothermic circulatory arrest during distal anastomosis
General Thoracic and Cardiovascular Surgery
(central temperature of 24–28 °C). During the circulatory arrest, antegrade selective (10 ml/min/kg) or retrograde cerebral perfusion was performed for brain protection. After the completion of distal anastomosis, retrograde/antegrade perfusion for the lower body and rewarming were initiated. The details of the operation are described in Table 1.
Glucose monitoring and management In the STG-55® group, glucose concentration was controlled to maintain a constant level of 150 mg/dl. C
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