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J Thorac Cardiovasc Surg 1997;113:942-948
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

EFFECT OF PREOPERATIVE SUPPLEMENTATION WITH -TOCOPHEROL AND ASCORBIC ACID ON MYOCARDIAL INJURY IN PATIENTS UNDERGOING CARDIAC OPERATIONS

Supported by grants from The Private Practice Trust Fund, Royal Brisbane Hospital, and The Prince Charles Hospital Private Practice Research & Education Trust Fund SSAC93/8/05 and L25540.

Received for publication Jan. 29, 1996 revisions requested March 11, 1996; revisions received Nov. 11, 1996 accepted for publication Dec. 9, 1996. Address for reprints: J. Westhuyzen, PhD, Conjoint Renal Laboratory, Royal Brisbane Hospital, Herston 4029, Brisbane, Australia.

Abstract

Augmentation of antioxidant defenses may help protect tissues against ischemia-reperfusion injury associated with operations involving cardiopulmonary bypass. In this study we examined the effect of pretreating patients with -tocopherol (vitamin E) and ascorbic acid (vitamin C) or placebo on injury to the myocardium. Seventy-six subjects undergoing elective coronary artery bypass grafting participated in a prospective, double-blind, placebo-controlled randomized trial, receiving either placebo or both 750 IU dl--tocopherol per day for 7 to 10 days and 1 gm ascorbic acid 12 hours before the operation. Plasma -tocopherol concentrations, raised fourfold by supplementation, fell by 70% after the operation in the supplemented group and to negligible levels in the placebo group. There were no significant differences between the groups with respect to release of creatine kinase MB isoenzyme over 72 hours, nor in the reduction of the myocardial perfusion defect determined by thallium 201 uptake. Electrocardiography provided no evidence of a benefit from antioxidant supplementation. Thus the supplementation regimen prevented the depletion of the primary lipid soluble antioxidant in plasma, but provided no measurable reduction in myocardial injury after the operation.

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