PURPOSE: Report the effect of Vitamin C on the incidence of AF after major cardiac surgery in a heterogeneous patient population at a busy cardiac surgery center (Washington Heart Institute, Washington Hospital Center, Washington, DC).
METHODS: After reviewing the results of Eslami et al, we instituted a prophylactic protocol modeled after their methods where all patients undergoing major cardiac surgery were given 2 grams of Vitamin C enterally the night before surgery then 1 gram twice daily starting on the day of surgery for 5 days. The protocol was implemented on February 2008. Exclusion criteria included allergy or sensitivity to Vitamin C, inability to tolerate enteral intake, and end-stage renal disease. All patients were monitored with telemetry postoperatively. The incidence of AF was defined as the detection of AF lasting more than 20 minutes continuously, a cumulative time of 1 hour in a 24-hour period, or requiring intervention.
RESULTS: As identified in the Society of Thoracic Surgery Database, 598 patients underwent major cardiac surgery and received perioperative Vitamin C at our institution between February 2008 and July 2008. Of the 598, only 142 patients received the complete perioperative regimen of Vitamin C described by the protocol and the incidence of AF in this group was 21.8%. The overall incidence of AF in patients undergoing major cardiac surgery at our institution in 2007 was 28.2% in 1,589 patients. We compared the two groups using a two-sample proportion test and found no statistical significance (p = 0.10) in the incidence of AF.
CONCLUSION: Administration of Vitamin C perioperatively did not show a significant decrease in the incidence of AF in a heterogeneous patient population undergoing major cardiac surgery.
CLINICAL IMPLICATIONS: Vitamin C ameliorates the inflammatory effect of ischemia and reperfusion injury. The inflammatory milieu may contribute to the development of postoperative AF in major cardiac surgery. Vitamin C can be safely administered to patients undergoing cardiac surgery. Its effect on the incidence of AF is unclear in a heterogeneous patient population.
DISCLOSURE: Tariq Ibrahim, No Financial Disclosure Information; No Product/Research Disclosure Information