PYRUVATE UPS HEART SURGERY RECOVERY ODDS
Investigators at the UNT Health Science Center are collaborating on a clinical research project that may hold the first major advance of its kind in more than a decade of heart disease research and treatment.
The new trial takes years of laboratory research by Robert Mallet, PhD, associate professor of integrative physiology, to the operating room where cardiac surgeon Albert Yurvati, DO, assistant professor of surgery, is testing its effectiveness in improving patient recovery after cardiac by-pass surgery.
Dr. Mallet has been investigating energy sources used by the heart during and following cardiac by-pass surgery for 15 years. He has discovered that one particular fuel source, the natural anti-oxidant pyruvate, is superior to other physiological fuels in providing a greater amount of energy to the heart following surgical cardiac arrest.
Dr. Mallettâ??s work has already proven pyruvateâ??s ability to bolster the effectiveness of drugs used during cardiac surgery to stimulate the heartâ??s function, allowing surgeons to administer lower, safer doses of the drugs. That earlier study was taken to the clinical trial phase by surgeons in Germany.
Dr. Mallet explained that while the heart is stopped, it resembles a car that has run out of gas, and pyruvate is like a high-octane fuel. Surgeons performing by-pass surgery use a potassium-based solution called cardioplegia to cause the heart to stop beating during surgery. During surgical arrest, the natural anti-oxidants that work to prevent tissue damage caused by free radicals are depleted, leaving the heart vulnerable to oxidative injury. By supplying pyruvate, this oxidative damage may be reduced or eliminated, thus accelerating the recovery process, Dr. Mallet said.
Pyruvate has been added to the cardioplegia solution in 30 by-pass patients, and all of the patients have experienced improved and more rapid cardiac recovery following surgery, he said. The use of pyruvate is also associated with a 50 percent reduction in the amount of supplemental drugs typically necessary to help patients recover.
Additionally, protein analyses have provided evidence that pyruvate is helping to protect the heart from oxidative damage during surgery. No adverse side effects have been observed with the addition of pyruvate, and many patientsâ?? hospital stay is a day less than typically required.
Dr. Mallet said that in addition to the health and quality of life benefits of this procedure for patients, it may actually be associated with cost savings due to a reduced need for recovery drugs and earlier patient release. â??The cost of adding pyruvate to cardioplegia is miniscule in comparison to the cost-saving potential of this procedure,â? he said.
Surgeons may soon see similar benefits of pyruvate in other types of cardiac surgery and in treating cardiac trauma. Drs. Mallet and Yurvati have recently been awarded a $235,000 grant from the Osteopathic Heritage Foundation to expand the scope of their study. Dr. Mallet also has been awarded a $1 million grant from the National Institutes of Health to conduct further pre-clinical studies with pyruvate.
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