Pre-operative Preparation for Cardiac Surgery Utilising a Combination of Metabolic, Physical and Mental Therapy

Cardiac surgery represents major metabolic, physical and mental stresses associated with an increased production of reactive oxygen species. These stresses may hamper post-operative recovery, increasing hospitalisation times and operative mortality. We conducted a quality assurance and feasibility study to evaluate and monitor the safety and efficacy of a new program of combined pre-operative metabolic (enhanced antioxidant), physical and mental therapy to counter these stresses prior to cardiac surgery.

Methods

Sixteen cardiac surgery patients received metabolic therapy consisting of the antioxidants coenzyme Q₁₀ (CoQ₁₀) (300mg) and α-lipoic acid (300mg), combined with magnesium orotate (1200mg), and omega-3 fatty acids (3g) given daily for a mean 36±7 days up until the day of operation. Patients also received a regimen of physical therapy incorporating non-exhaustive, light exercise and stretching techniques. Mental therapy in the form of stress reduction, relaxation and music was also provided. Blood levels of CoQ₁₀ and malondialdehyde (MDA) were measured and a quality of life (QoL) questionnaire (SF-36) was administered before, after the program and 1 month after surgery. A patient satisfaction survey was conducted at six weeks post-operatively.

Results

During the pre-operative period, treated patients (n=16) showed significant improvements in QoL composite scores, physical (33.5±4.1 to 41.0±4.5, p=0.005) and mental (44.3±4.5 to 54.1±5.3, p=0.006). CoQ₁₀ levels increased from 725.6±96.1nmol/l to 3019.9±546.4nmol/l (p=0.006), MDA levels decreased from 2.2±0.9μM to 1.4±0.7μM (p=0.013) and systolic blood pressure decreased from 140±4.0mmHg to 132±3.0mmHg (p=0.002). One month after surgery the treated group (n=14) demonstrated significant improvements from pre-operative baseline in QoL composite scores, physical (38.9±4.0 to 57.9±5.4, p=0.01) and mental (50.3±5.6 to 69.3±4.8, p=0.03) compared to a previously reported similar group of cardiac surgery patients (n=74) whose physical and mental scores decreased from 43.0 to 42.8 (p=0.05) and 53.8 to 49.8, respectively (p=0.05).

Conclusion

These preliminary results suggest that a program of combined metabolic, physical and mental preparation before cardiac surgery is safe, feasible and may improve quality of life, lower systolic blood pressure, reduce levels of oxidative stress and thus has the potential to enhance post-operative recovery.

Keywords: Cardiac surgery, Coenzyme Q₁₀, Magnesium orotate, α-Lipoic acid, Omega-3-fatty acids, Music, Relaxation