Spike in glucose levels after reperfusion during aortic surgery: assessment by continuous blood glucose monitoring using artificial endocrine pancreas

Abstract

Although strict blood glucose control during cardiovascular surgery is essential to avoid postoperative complications, the various changes in glucose levels that occur during surgery have not been investigated in detail. In this study, we continuously monitored blood glucose changes during aortic surgery using the STG-55Ⓡ artificial endocrine pancreas (Nikkiso Inc., Tokyo). Between December 2015 and 2016, we performed continuous blood glucose monitoring in 22 patients (14 men and 8 women, 72 ± 11years old), who required hypothermic circulatory arrest during an ascending/aortic arch surgery, at the Jichi Medical University Hospital. Ascending aorta replacements were performed in two patients and partial/total arch replacement, in 20. All the patients required selective cerebral perfusion and hypothermic circulatory arrest (bladder temperature at 25-26°C) during distal anastomosis. Closed-loop continuous blood glucose monitoring was performed during cardiopulmonary bypass using the STG-55Ⓡ artificial endocrine pancreas (Nikkiso Co., LTD, Tokyo). Blood glucose concentrations did not increase significantly from the time of the commencement of cardiopulmonary bypass to lower body ischemia. However, they dramatically increased immediately after reperfusion following lower body ischemia, and this hyperglycemia was sustained until the end of cardiopulmonary bypass. The current study clarified the peak glucose concentration during aortic surgery. These data may contribute to the management of blood glucose levels during aortic surgery.