Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiothoracic Surgery Pub Date : 2025-05-22 DOI:10.1186/s13019-025-03486-8

Patrick M Wieruszewski, Misty A Radosevich, Scott D Nei, Kianoush B Kashani, Sarah E Normand, Hartzell V Schaff, Erica D Wittwer

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引用次数: 0

Abstract

Background: Ascorbic acid is an essential cofactor of catecholamine synthesis that increases capillary bed density and improves microcirculation perfusion. We hypothesized early ascorbic acid administration in cardiothoracic surgery would preserve the microcirculatory integrity and minimize postoperative vasoplegia.

Methods: This was a single-arm pilot feasibility study of adults undergoing septal myectomy combined with valve intervention or alone using cardiopulmonary bypass. Intravenous ascorbic acid 1,500 mg was administered before and immediately following cardiopulmonary bypass and every 6 h after for 12 doses. Three historical controls were identified and matched to each trial participant on age, gender, body mass index, preoperative ejection fraction, surgery performed, and time on cardiopulmonary bypass. The feasibility endpoint was a composite of successful and timely 1) ascorbic acid administration, 2) laboratory assessment, and 3) microcirculation measurements across the perioperative phases of care. Clinical endpoints included vasoplegia incidence, acute kidney injury, and lengths of stay compared to controls.

Results: Fifteen patients were enrolled and compared to 45 historically matched controls. Participants' median baseline plasma ascorbic acid concentration was 0.5 (0.3, 0.9) mg/dL. Four (27%) patients had suboptimal concentrations. Eleven participants (75%) did not meet the feasibility composite endpoint due to the inability of microcirculation measurement. Incidence of vasoplegia and acute kidney injury, vasopressor duration, and lengths of stay were similar between participants and historical controls. No drug-related adverse events were noted.

Conclusions: Timely microcirculation measurements were challenging in the complex cardiothoracic surgery environment. Compared to historical controls, no meaningful differences in clinical endpoints were noted with ascorbic acid treatment. The utility of ascorbic acid on post-cardiopulmonary bypass vasoplegia remains unclear.

Trial registration: ClinicalTrials.gov (NCT03744702, registered on November 14, 2018).

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心胸外科手术中抗坏血酸和微循环：一项试点可行性试验和匹配队列研究。

背景：抗坏血酸是儿茶酚胺合成的重要辅助因子，可增加毛细血管床密度，改善微循环灌注。我们假设在心胸外科手术中早期给予抗坏血酸可以保持微循环的完整性并减少术后血管截瘫。方法：这是一项单臂试点可行性研究，成人行膈肌切除术联合瓣膜介入或单独使用体外循环。静脉注射抗坏血酸1500 mg，于体外循环术前及术后立即给予，术后每6 h给予一次，共12剂。确定了三个历史对照，并根据年龄、性别、体重指数、术前射血分数、手术次数和体外循环时间与每个试验参与者相匹配。可行性终点是成功和及时的综合1)抗坏血酸给药，2)实验室评估，3)围手术期微循环测量。临床终点包括血管截瘫发生率、急性肾损伤和与对照组相比的住院时间。结果：15名患者入组，并与45名历史匹配的对照组进行比较。参与者的中位基线血浆抗坏血酸浓度为0.5 (0.3,0.9)mg/dL。4例（27%）患者浓度不理想。11名参与者（75%）由于无法进行微循环测量而未达到可行性综合终点。血管截瘫和急性肾损伤的发生率、血管加压持续时间和住院时间在参与者和历史对照组之间相似。未发现与药物相关的不良事件。结论：在复杂的心胸外科环境中，及时进行微循环测量具有挑战性。与历史对照相比，抗坏血酸治疗在临床终点上没有显著差异。抗坏血酸在体外循环后血管截瘫中的应用尚不清楚。试验注册：ClinicalTrials.gov （NCT03744702，注册于2018年11月14日）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiothoracic Surgery 医学-心血管系统

CiteScore

2.50

自引率

6.20%

发文量

286

审稿时长

4-8 weeks

期刊介绍： Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.