title: Perioperative metabolic therapy improves redox status and outcomes in cardiac surgery patients: a randomised trial.
abstract: 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.
authors.affiliation: Cardiac Surgical Research Unit, Alfred Hospital, Department of Surgery Monash University, Baker IDI Institute, Melbourne, Australia.
authors.forename: Jee-Yoong
authors.initials: JY
authors.lastname: Leong
authors.forename: Juliana
authors.initials: J
authors.lastname: van der Merwe
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pepe
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Anthony
authors.initials: A
authors.lastname: Perkins
authors.forename: Robyn
authors.initials: R
authors.lastname: Lymbury
authors.forename: Donald
authors.initials: D
authors.lastname: Esmore
authors.forename: Silvana
authors.initials: S
authors.lastname: Marasco
authors.forename: Franklin
authors.initials: F
authors.lastname: Rosenfeldt
mesh_terms: 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
chemical_list: 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