Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial.
OBJECTIVE
Perioperative therapy with antioxidants and metabolic substrates has the potential to reduce oxidative stress and improve recovery from cardiac surgery, particularly in elderly and high risk cases. The aim of this study was to assess the effect of perioperative metabolic therapy at a biochemical, clinical and economic level in cardiac surgical patients.


METHODS
Patients (n=117, mean age 65 ± 1.0 years, 74% male) undergoing elective coronary artery bypass graft (CABG) and/or valve surgery in 2004-2006 were randomised to receive in double blinded fashion, while on the waiting list for surgery (approximately two months) and one month after surgery, either metabolic therapy (coenzyme Q(10), magnesium orotate, lipoic acid, omega-3 fatty acids and selenium) or placebo. Biochemical and clinical outcomes were assessed.


RESULTS
Cardiac surgery increased oxidative stress and decreased plasma levels of key antioxidants. Metabolic therapy for a mean of 76 ± 7.5 days increased antioxidant levels preoperatively so that the adverse effect of surgery on redox status was attenuated. Metabolic therapy reduced plasma troponin I, 24 hours postoperatively from 1.5 (1.2-1.8) (geometric mean 95% CI) μg/L, to 2.1 (1.8-2.6) μg/L (P=0.003) and shortened the mean length of postoperative hospital stay by 1.2 days from 8.1 (7.5-8.7) to 6.9 (6.4-7.4) days (P=0.004) and reduced hospital costs. Metabolic therapy was inexpensive and had no clinically significant side effects.


CONCLUSIONS
Perioperative metabolic therapy for cardiac surgery is safe and inexpensive and is associated with improved redox status, reduced myocardial damage, and shortened length of postoperative hospital stay.
Leong
Jee-Yoong
JY
Cardiac Surgical Research Unit, Alfred Hospital, Department of Surgery Monash University, Baker IDI Institute, Melbourne, Australia.
van der Merwe
Juliana
J
Pepe
Salvatore
S
Bailey
Michael
M
Perkins
Anthony
A
Lymbury
Robyn
R
Esmore
Donald
D
Marasco
Silvana
S
Rosenfeldt
Franklin
F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001315:Australia; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D016001:Confidence Intervals; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D019990:Perioperative Care / Q000379:methods*; D017382:Reactive Oxygen Species; D013223:Statistics as Topic; D013312:Stress, Physiological; D016896:Treatment Outcome; D014451:Ubiquinone / Q000031:analogs & derivatives / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D000975:Antioxidants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017382:Reactive Oxygen Species; D014451:Ubiquinone; C024989:coenzyme Q10