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J Thorac Cardiovasc Surg 1994;108:311-320
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Depletion of plasma vitamin C but not of vitamin E in response to cardiac operations

Berne and Basel, Switzerland

Received for publication June 17, 1993. Accepted for publication Jan. 18, 1994. Address for reprints: P. E. Ballmer, MD, Department of Medicine, Inselspital, CH-3010 Berne, Switzerland.

Abstract

The whole-body inflammatory response produced by cardiopulmonary bypass is an important cause of perioperative morbidity after cardiac operations. This inflammatory response produces reactive oxygen species and other cytotoxic substances, such as the cytokines. The generation of reactive oxygen species might deplete principal antioxidant micronutrients, that is, vitamins C and E and the carotenoids. Therefore, we have investigated the time course of the plasma concentrations of vitamins C and E and the carotenoids in 18 patients undergoing coronary bypass operations after randomization for previous vitamin E supplementation (300 mg dl--acetyl-tocopherol 3 times daily for 4 weeks) or placebo. Supplementation with-tocopherol doubled the lipid-standardized plasma vitamin E concentration to 63.7 ± 14.5µmol/L when compared with that of the control subjects (31.2 ± 9.0µmol/L) before the operation. The plasma concentrations of vitamin C (36.0 ± 19.0µmol/L and 44.0 ± 21.7µmol/L, respectively) and of the carotenoids were not statistically different between the two groups at baseline. The absolute plasma concentrations of both vitamin E and the carotenoids decreased during and after cardiopulmonary bypass, but after correction for hemodilution the plasma concentrations of vitamin E and the carotenoids showed no decrease. The vitamin E concentrations in the erythrocytes did not change either. In contrast, the plasma concentration of vitamin C decreased in all subjects within 24 hours after the operation by roughly 70%. Correction for hemodilution still revealed a significant decrease in plasma vitamin C that persisted in most patients up to 2 weeks. In conclusion, the vitamin E and the carotenoid plasma concentrations are of no major concern during and after cardiac operations. In contrast, the serious depletion of vitamin C may deteriorate the defense against reactive oxygen species–induced injury during cardiac operations. (J THORACCARDIOVASCSURG1994;108:311-20)

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