Vitamin E for coronary bypass operations

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Presentation transcript:

Vitamin E for coronary bypass operations Terrence M. Yau, MD, CM, Richard D. Weisel, MD, Donald A.G. Mickle, MD, Graham W. Burton, PhDa, Keith U. Ingold, PhDa, Joan Ivanov, RN, Molly K. Mohabeer, BSc, Laura Tumiati, BSc, Susan Carson, AHT, RLAT The Journal of Thoracic and Cardiovascular Surgery Volume 108, Issue 2, Pages 302-310 (August 1994) DOI: 10.5555/uri:pii:S0022522394700125 Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 1 Total myocardial alpha-tocopherol concentrations (nmol/gm wet weight) before cardioplegia (PREOP) were significantly(p < 0.05) greater in patients who had received 300 or 900 mg D3-2R,4′R,8′R-alpha-tocopherol (D3-tocopherol) a day for 14 days than in patients in the placebo group. The patients who received 100 mg a day for 14 days had tocopherol levels that were not different from those of the placebo patients (p > 0.05). In the patients receiving 300 and 900 mg deuterated alpha-tocopherol, a modest fall (p < 0.05) in total alpha-tocopherol levels occurred after crossclamp release (XCL OFF), with recovery after 20 minutes of reperfusion (REPERFUSION). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 2 Myocardial D3-2R,4′R,8′R-alpha-tocopherol(D3-tocopherol) concentrations (nmol/gm wet weight) accounted for the increase in total alpha-tocopherol levels. Deuterated alpha-tocopherol levels were consistently increased in the patients who received 300 or 900 mg a day for 14 days and not in those who received 100 mg per day for 14 days. There were no significant changes in deuterated alpha-tocopherol after crossclamp (XCL OFF) and after 20 minutes of reperfusion (REPERFUSION). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 3 The change in myocardial lactate extraction (Δ LEX) in response to the mild hemodynamic stress of atrial pacing (110 beats/min for 5 minutes) is depicted as a percent change from baseline. Pacing on bypass (on CPB) induced lactate release in placebo control patients but an increase in lactate extraction in tocopherol-treated patients (p < 0.05). No differences were seen between groups with pacing 25 minutes after discontinuation of bypass (OFF CPB) or 4 hours after the operation (POSTOP). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 4 The increase in myocardial oxygen consumption (MVO2) with atrial pacing (expressed as a change from baseline) was similar for placebo control and vitamin E–treated patients on bypass (ON CPB), 25 minutes after discontinuation of bypass (OFF CPB), and after the operation (POSTOP). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 5 Diastolic compliance (the relation between the diastolic intraventricular pressures and the diastolic volume indices, EDVI) was different (p < 0.05) by an analysis of covariance (ANOCOVA). The placebo control patients had higher pressures at lower volumes than the alpha-tocopherol-treated patients. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions

Fig. 6 Arterial CK-MB activity was greater in the placebo control than the alpha–tocopherol–treated patients (p < 0.05 by analysis of variance). The differences were greatest 8 and 16 hours after the operation (p < 0.05 by Duncan's test). The Journal of Thoracic and Cardiovascular Surgery 1994 108, 302-310DOI: (10.5555/uri:pii:S0022522394700125) Copyright © 1994 Mosby, Inc. Terms and Conditions