Utility of bedside artificial pancreas for postoperative glycemic control in cardiac surgery.

Perioperative hyperglycemia, hypoglycemia, and high glycemic variability are independent risk factors for mortality in critically ill patients. After cardiac surgery, intensive glycemic control without hypoglycemia may help to reduce the number of adverse events; however, postoperative glycemic control is difficult in many cases. In this study, we investigated whether the bedside artificial pancreas STG-55 is useful for postoperative glycemic control in cardiac surgery. METHODS: In the present single-center retrospective study, we analyzed arterial blood glucose levels for 15 h after surgery in 69 patients treated using the bedside artificial pancreas and in 160 patients treated with continuous intravenous insulin infusion using a scale that adjusts for current blood glucose level, glycemic fluctuation, and insulin dose. RESULTS: Hypoglycemia (arterial blood glucose level < 70 mg/dL) was not observed in any case. Patients in the group treated using the bedside artificial pancreas showed lower mean, maximum, and minimum blood glucose levels and glycemic variability and shorter treatment duration in the intensive care unit than patients treated with continuous intravenous insulin infusion. Notably, these results were not affected by diabetes status or differences in operative procedures. Analysis of patients undergoing isolated coronary artery bypass grafting surgery revealed that the incidence of surgical site complications composite with infection and dehiscence was lower. CONCLUSIONS: In cardiac surgery, postoperative treatment using bedside artificial pancreas is a novel therapy that improves hyperglycemia and glycemic variability, without hypoglycemia, and is, therefore, an attractive strategy for future surgeries.

Endovascular Repair of a Secondary Aortoenteric Fistula / 日本心臓血管外科学会雑誌

A 71-year-old man who had undergone repair of a ruptured abdominal aortic aneurysm with a tube graft 3 months ago was transferred from another hospital with an Aortoenteric Fistula (AEF) for surgical treatment. Computed tomographic (CT) angiography revealed pseudoaneurysm formation at the proximal anastomotic site. Waiting for the elective operation, he developed massive hematemesis with shock. Endovascular stent-graft repair was emergently performed because of high risk for conventional open surgery. Gastrointestinal bleeding was successfully controlled. The psuedoaneurysm disappeared, which was confirmed by postoperative CT angiography. At 1-year follow-up, he has shown no clinical and radiographic evidence of recurrent infection or bleeding. For the case with shock, Endovascular repair could be a bridge to open surgery because it is fast and minimally invasive. Endovascular repair of AEF is technically feasible and may be the definitive treatment in selected patients without signs of infection and gastrointestinal bleeding.