Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study
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...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-025-03486-8 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850127932358393856 |
|---|---|
| author | Patrick M. Wieruszewski Misty A. Radosevich Scott D. Nei Kianoush B. Kashani Sarah E. Normand Hartzell V. Schaff Erica D. Wittwer |
| author_facet | Patrick M. Wieruszewski Misty A. Radosevich Scott D. Nei Kianoush B. Kashani Sarah E. Normand Hartzell V. Schaff Erica D. Wittwer |
| author_sort | Patrick M. Wieruszewski |
| collection | DOAJ |
| description | 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). |
| format | Article |
| id | doaj-art-ea2ae8a57bcd4646a8239b27d7bbf517 |
| institution | OA Journals |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-ea2ae8a57bcd4646a8239b27d7bbf5172025-08-20T02:33:32ZengBMCJournal of Cardiothoracic Surgery1749-80902025-05-012011910.1186/s13019-025-03486-8Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort studyPatrick M. Wieruszewski0Misty A. Radosevich1Scott D. Nei2Kianoush B. Kashani3Sarah E. Normand4Hartzell V. Schaff5Erica D. Wittwer6Department of Pharmacy, Mayo ClinicDepartment of Anesthesiology, Mayo ClinicDepartment of Pharmacy, Mayo ClinicDepartment of Nephrology and Hypertension, Mayo ClinicDepartment of Pharmacy, Mayo ClinicDepartment of Cardiovascular Surgery, Mayo ClinicDepartment of Anesthesiology, Mayo ClinicAbstract 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).https://doi.org/10.1186/s13019-025-03486-8VasoplegiaVasodilationShockVitamin CCardiopulmonary bypassMicrocirculation |
| spellingShingle | Patrick M. Wieruszewski Misty A. Radosevich Scott D. Nei Kianoush B. Kashani Sarah E. Normand Hartzell V. Schaff Erica D. Wittwer Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study Journal of Cardiothoracic Surgery Vasoplegia Vasodilation Shock Vitamin C Cardiopulmonary bypass Microcirculation |
| title | Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study |
| title_full | Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study |
| title_fullStr | Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study |
| title_full_unstemmed | Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study |
| title_short | Ascorbic acid and microcirculation in cardiothoracic surgery: a pilot feasibility trial and matched cohort study |
| title_sort | ascorbic acid and microcirculation in cardiothoracic surgery a pilot feasibility trial and matched cohort study |
| topic | Vasoplegia Vasodilation Shock Vitamin C Cardiopulmonary bypass Microcirculation |
| url | https://doi.org/10.1186/s13019-025-03486-8 |
| work_keys_str_mv | AT patrickmwieruszewski ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT mistyaradosevich ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT scottdnei ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT kianoushbkashani ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT sarahenormand ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT hartzellvschaff ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy AT ericadwittwer ascorbicacidandmicrocirculationincardiothoracicsurgeryapilotfeasibilitytrialandmatchedcohortstudy |