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Franklin Rosenfeldt
Silvana Marasco
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J Thorac Cardiovasc Surg 2005;129:25-32
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue

Franklin Rosenfeldt, MD, FRACSa,b, Silvana Marasco, FRACSa, William Lyon, MBBSa, Michelle Wowk, BSc(Hons)a, Freya Sheeran, BA, BSc(Hons)a, Michael Bailey, MSc(Stats)b, Donald Esmore, FRACSa, Bruce Davis, FRACSa, Adrian Pick, FRACSa, Mark Rabinov, PhD, FRACSa, Julian Smith, MSurg, FRACSa, Phillip Nagley, PhD, DScc, Salvatore Pepe, PhDa,*

a The Cardiac Surgical Research Unit, Department of Cardiothoracic Surgery, Alfred Hospital, the Baker Heart Research Institute (Wynn Domain), and the Department of Surgery, Monash University, Melbourne, Australia
b Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
c Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Australia

Received for publication September 3, 2003; revisions received March 15, 2004; accepted for publication March 25, 2004.

* Address for reprints: Salvatore Pepe, PhD, Baker Heart Research Institute, PO Box 6492, St Kilda Road Central, Melbourne VIC 8008, Australia
spepe{at}baker.edu.au

OBJECTIVES: Previous clinical trials suggest that coenzyme Q10 might afford myocardial protection during cardiac surgery. We sought to measure the effect of coenzyme Q10 therapy on coenzyme Q10 levels in serum, atrial trabeculae, and mitochondria; to assess the effect of coenzyme Q10 on mitochondrial function; to test the effect of coenzyme Q10 in protecting cardiac myocardium against a standard hypoxia-reoxygentation stress in vitro; and to determine whether coenzyme Q10 therapy improves recovery of the heart after cardiac surgery.

METHODS: Patients undergoing elective cardiac surgery were randomized to receive oral coenzyme Q10 (300 mg/d) or placebo for 2 weeks preoperatively. Pectinate trabeculae from right atrial appendages were excised, and mitochondria were isolated and studied. Trabeculae were subjected to 30 minutes of hypoxia, and contractile recovery was measured. Postoperative cardiac function and troponin I release were assessed.

RESULTS: Patients receiving coenzyme Q10 (n = 62) had increased coenzyme Q10 levels in serum (P = .001), atrial trabeculae (P = .0001), and isolated mitochondria (P = .0002) compared with levels seen in patients receiving placebo (n = 59). Mitochondrial respiration (adenosine diphosphate/oxygen ratio) was more efficient (P = .012), and mitochondrial malondialdehyde content was lower (P = .002) with coenzyme Q10 than with placebo. After 30 minutes of hypoxia in vitro, pectinate trabeculae isolated from patients receiving coenzyme Q10 exhibited a greater recovery of developed force compared with those in patients receiving placebo (46.3% ± 4.3% vs 64.0% ± 2.9%, P = .001). There was no between-treatment difference in preoperative or postoperative hemodynamics or in release of troponin I.

CONCLUSIONS: Preoperative oral coenzyme Q10 therapy in patients undergoing cardiac surgery increases myocardial and cardiac mitochondrial coenzyme Q10 levels, improves mitochondrial efficiency, and increases myocardial tolerance to in vitro hypoxia-reoxygenation stress.




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