title: Pre-operative preparation for cardiac surgery utilising a combination of metabolic, physical and mental therapy.
abstract: Cardiac surgery represents major metabolic, physical and mental stresses associated with an increased production of reactive oxygen species. These stresses may hamper post-operative recovery, increasing hospitalisation times and operative mortality. We conducted a quality assurance and feasibility study to evaluate and monitor the safety and efficacy of a new program of combined pre-operative metabolic (enhanced antioxidant), physical and mental therapy to counter these stresses prior to cardiac surgery.
  
  
  METHODS
  Sixteen cardiac surgery patients received metabolic therapy consisting of the antioxidants coenzyme Q(10) (CoQ(10)) (300 mg) and alpha-lipoic acid (300 mg), combined with magnesium orotate (1200 mg), and omega-3 fatty acids (3g) given daily for a mean 36+/-7 days up until the day of operation. Patients also received a regimen of physical therapy incorporating non-exhaustive, light exercise and stretching techniques. Mental therapy in the form of stress reduction, relaxation and music was also provided. Blood levels of CoQ(10) and malondialdehyde (MDA) were measured and a quality of life (QoL) questionnaire (SF-36) was administered before, after the program and 1 month after surgery. A patient satisfaction survey was conducted at six weeks post-operatively.
  
  
  RESULTS
  During the pre-operative period, treated patients (n=16) showed significant improvements in QoL composite scores, physical (33.5+/-4.1 to 41.0+/-4.5, p=0.005) and mental (44.3+/-4.5 to 54.1+/-5.3, p=0.006). CoQ(10) levels increased from 725.6+/-96.1 nmol/l to 3019.9+/-546.4 nmol/l (p=0.006), MDA levels decreased from 2.2+/-0.9 microM to 1.4+/-0.7 microM (p=0.013) and systolic blood pressure decreased from 140+/-4.0 mmHg to 132+/-3.0 mmHg (p=0.002). One month after surgery the treated group (n=14) demonstrated significant improvements from pre-operative baseline in QoL composite scores, physical (38.9+/-4.0 to 57.9+/-5.4, p=0.01) and mental (50.3+/-5.6 to 69.3+/-4.8, p=0.03) compared to a previously reported similar group of cardiac surgery patients (n=74) whose physical and mental scores decreased from 43.0 to 42.8 (p=0.05) and 53.8 to 49.8, respectively (p=0.05).
  
  
  CONCLUSIONS
  These preliminary results suggest that a program of combined metabolic, physical and mental preparation before cardiac surgery is safe, feasible and may improve quality of life, lower systolic blood pressure, reduce levels of oxidative stress and thus has the potential to enhance post-operative recovery.
authors.affiliation: Cardiac Surgical Research Unit, Department of Cardiothoracic Surgery, Monash University, Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hadj
authors.forename: Donald
authors.initials: D
authors.lastname: Esmore
authors.forename: Michael
authors.initials: M
authors.lastname: Rowland
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pepe
authors.forename: Lawrence
authors.initials: L
authors.lastname: Schneider
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lewin
authors.forename: Franklin
authors.initials: F
authors.lastname: Rosenfeldt
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D003067:Coenzymes; D017558:Elective Surgical Procedures; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000628:therapy*; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D018384:Oxidative Stress; D011300:Preoperative Care / Q000379:methods; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control; D014451:Ubiquinone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D000975:Antioxidants; D003067:Coenzymes; D014451:Ubiquinone; D008315:Malondialdehyde; C024989:coenzyme Q10