Of 30 consecutive patients undergoing mitral valve replacement, 15 were randomly assigned to receive pretreatment with glucose-insulin-potassium, while the other 15 received the same volume of normal saline. The characteristics of both groups were similar and all patients were in New York Heart Association functional class III or IV. Papillary muscle samples were obtained at the time of surgery and analyzed for glycogen both biochemically and histochemically. The clinical course was monitored closely during the first 24 hours after surgery. The treated patients had significantly higher glycogen levels (mean, 43 ± 13.54 μmol·g−1) in their heart muscle samples compared to the controls (mean, 22 ± 10.39 μmol·g−1). The treated patients required less pharmacological inotropic support and they had fewer ventricular arrhythmias and more favorable cardiac output and systemic vascular resistance. However, there was no difference in postoperative pulmonary capillary wedge pressure or mortality between the 2 groups. It was concluded that pretreatment with glucose-insulin-potassium had a significant myocardial protective effect in patients in advanced functional class undergoing mitral valve replacement.
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