Glycemic profile in infants who have undergone the arterial switch operation: Hyperglycemia is not associated with adverse events

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 135; no. 4; pp. 739 - 745
• Main Authors: Rossano, Joseph W., MD, Taylor, Michael D., MD, PhD, Smith, E. O'Brian, PhD, Fraser, Charles D., MD, McKenzie, E. Dean, MD, Price, Jack F., MD, Dickerson, Heather A., MD, Nelson, David P., MD, PhD, Mott, Antonio R., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.04.2008; AATS/WTSA
• Subjects: Blood Glucose - analysis; Cardiac Surgical Procedures - adverse effects; Cardiothoracic Surgery; Female; Heart Defects, Congenital - surgery; Humans; Hyperglycemia - complications; Hypoglycemia - complications; Infant; Infant, Newborn; Male; Postoperative Period; SGV; AE; serum glucose value; adverse event; CVICU; cardiovascular intensive care unit; LOS; APC; arterial switch operation; length of stay; ASO; activated protein C; 21
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2007.11.030

Objective Tight glycemic control improves outcomes in critically ill adults. There are limited data regarding the effect of glycemic profiles in infants after cardiac operations. The aim of this study was to evaluate the association of hyperglycemia and hypoglycemia on adverse events in infants undergoing the arterial switch operation. Methods From 2000 through 2005, 93 infants underwent the arterial switch operation (mean age, 2.5 ± 5.9 weeks; mean weight, 3.4 ± 0.8 kg). All serum glucose values during the first 24 postoperative hours were documented. The effect of time spent in specific glycemic bands on adverse events was determined. Results Twenty-three (25%; group 1) infants spent more than 50% of the time with glucose values between 80 and 110 mg/dL, and 13 (14%; group 2) spent more than 50% of the time with glucose values of greater than 200 mg/dL. A total of 71 adverse events was documented in 45 (48%) of 93 infants. Group 1 infants were more likely to have any adverse event ( P = .001) and renal insufficiency ( P < .001). Group 2 infants were not more likely to have adverse events. When controlling for preoperative and operative factors, being in group 1 was an independent predictor of postoperative adverse events ( P = .004). Conclusion Hyperglycemia does not appear to be detrimental in postoperative infants with congenital heart disease. Infants who spent the majority of the time with glucose values between 80 and 110 mg/dL were at increased risk for adverse events. The ideal glycemic profile in the postoperative cardiac infant has yet to be defined.