Impact of perioperative selenium supplementation on perioperative hemodynamics in patients undergoing cardiac surgery: a post hoc analysis of the Sustain CSX trial
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Authors
Mohsen G.
Catena D.
Lee Z.Y.
Notz Q.
Jiang X.
Velten M.
O'Brien B.
KleineBrueggeney M.
Ott S.
Heyland D.K.
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2025
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Despite advancements in perioperative care, patients undergoing cardiac surgery continue to experience a relatively high incidence of complications and mortality. Identifying effective strategies to improve outcomes is a key priority for this high-risk population. Perioperative hypotension in patients undergoing cardiac surgery contribute to postoperative organ dysfunction, delirium, prolonged intensive care unit stays and higher mortality. These complications underscore the importance of interventions that support hemodynamic stability during and after surgery. Cardiac surgery patients are particularly vulnerable to hemodynamic instability due to the oxidative stress associated with cardiopulmonary bypass (CPB), ischemia reperfusion injury, and the systemic inflammatory response triggered by surgical trauma. These factors contribute to fluctuations in blood pressure, cardiac output and vascular resistance, increasing the risk of postoperative hypotension and the need for vasopressor or inotropic support. One of the most severe complications of cardiac surgery is low cardiac output syndrome (LCOS), a complication affecting 1â??25 % of adult cardiac surgery patients, encompassing a spectrum from mild microperfusion disturbances to severe cardiogenic shock requiring mechanical circulatory support and is a major determinant of postoperative morbidity and mortality. Selenium is an essential micronutrient with antioxidative and anti-inflammatory properties. Observational studies suggest that intraoperative selenium levels decrease in response to myocardial ischemia, prolonged CPB duration and reperfusion injury. These factors are also associated with hemodynamic instability and postoperative complications. In this context, the large, international, multicenter randomized controlled trial SustainCSX assessed the significance of intravenous selenium supplementation vs. placebo in patients undergoing cardiac surgery, but could not detect an effect on postoperative organ failure and mortality in cardiac surgery patients. In this post-hoc analysis of the SustainCSX trial, we examine the impact of high-dose selenium on the patients' perioperative hemodynamic profiles.
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Journal of Clinical Anesthesia
Volume
107