Vitamin E for coronary bypass operations : a prospective, double-blind, randomized trial

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 108; no. 2; pp. 302 - 310
• Main Authors: YAU, T. M, WEISEL, R. D, MICKLE, D. A. G, BURTON, G. W, INGOLD, K. U, IVANOV, J, MOHABEER, M. K, TUMIATI, L, CARSON, S
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier 01.08.1994
• Subjects: Adult; Aged; Biological and medical sciences; Coronary Artery Bypass; Creatine Kinase - blood; Dose-Response Relationship, Drug; Double-Blind Method; Heart - drug effects; Humans; Isoenzymes; Lactates - metabolism; Lactic Acid; Male; Medical sciences; Middle Aged; Myocardium - chemistry; Myocardium - metabolism; Oxygen Consumption; Premedication; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ventricular Function - drug effects; Vitamin E - analysis; Vitamin E - pharmacology; Vitamin E - therapeutic use; Human; Chemotherapy; Treatment; Aortocoronary; Bypass; Surgery; Cardiovascular disease; α-Tocopherol; Preoperative; Antioxidant; Coronary heart disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/s0022-5223(94)70012-5

Free radical lipid peroxidation contributes to the abnormal metabolism and ventricular function frequently seen after cardiac operations. Antioxidants may improve metabolic and functional recovery. A prospective, randomized, double-blind clinical trial was conducted to determine the effects of vitamin E (alpha-tocopherol) (n = 14) or a corn oil placebo (n = 14) in patients undergoing elective coronary bypass operations. The RRR-alpha-tocopheryl acetate doubled the alpha-tocopherol levels in the heart. Myocardial metabolism and ventricular function were assessed after the operation. Atrial pacing induced myocardial lactate production in the control patients but lactate consumption in the alpha-tocopherol-treated patients on bypass 25 minutes after crossclamp release. Left ventricular stroke work indices were higher, at similar ventricular volumes, in the alpha-tocopherol-treated group, which indicates improved preload recruitable stroke work, and diastolic compliance was greater 4 hours after the operation. The postoperative creatine kinase cardiac isoenzyme levels were lower in the patients who received alpha-tocopherol. Pretreatment with alpha-tocopherol sufficient to double the myocardial concentrations had a small but significant metabolic and functional effect after elective coronary bypass operations when compared with placebo. These results do not justify pretreatment of low-risk patients, but they do justify an evaluation in high-risk patients.