Abstract 2270: Preoperative Metabolic Therapy Improves Cardiac Surgical Outcomes: A Prospective Randomized Clinical Trial
In the current era the typical patient presenting for cardiac surgery is elderly with multiple co-morbidities. These high-risk patients contribute disproportionately to postoperative morbidity and mortality. We have shown that metabolic therapy with antioxidants such as coenzyme Q10 (Co Q10) and lipoic acid as well as energy substrate precursors such as orotate have protective effects on the stressed myocardium. We postulated that such therapy would reduce myocardial damage and improve post-operative recovery.
Aim: To assess the effects of perioperative metabolic therapy on clinical and biochemical outcomes of cardiac surgery.
Methods: Patients (n=117), mean age 65 years, 74% male, undergoing elective coronary artery bypass graft (CABG) or valve surgery were randomised to receive daily for a minimum of 2 weeks before, and 4 weeks after surgery, metabolic therapy consisting of CoQ10 300mg, magnesium orotate 1.2g, alpha lipoic acid 300mg, fish oil 999 mg and selenium 200 μg or placebo.
Results: In the whole group, metabolic therapy vs placebo was associated (multivariate analysis) with lower 24-hour postoperative plasma troponin I (1.44 ± 0.25 vs 2.65 ± 0.61 ug/L, p=0.003) and reduced postoperative hospital stay (6.9± 0.04 vs 8.1 ± 0.04 days, p=0.002). In CABG alone group (n=70), metabolic therapy reduced the incidence of postoperative atrial fibrillation (23% vs 46%, p=0.04, multivariate analysis).
Conclusions: Metabolic therapy before cardiac surgery is associated with:
Reduced myocardial damage (troponin I release);
Shortened postoperative hospital stay;
Reduced incidence of postoperative atrial fibrillation in CABG patients.
Clinical and economic benefits may be expected from general application of this therapy.