Vitamin D analogue may benefit valve-replacement surgery patients

For patients undergoing valve-replacement surgery, early treatment with alfacalcidol is well tolerated and may shorten the duration of intensive care unit (ICU) stay, a study has found.

Most critically ill patients are vitamin-D deficient, and vitamin D deficiency may contribute to worse prognosis and prolonged hospital length of stay (LOS). Those receiving open-heart surgery are especially at risk due to the associated life-threatening postoperative complications. Therefore, the study examined the effect of treatment with alfacalcidol 2 μg/d started 48 h before surgery and continued throughout the hospital stay.

A total of 89 adult patients undergoing valve-replacement surgery were randomized to receive the vitamin D analogue (n=47) or no treatment (n=42). All of them were also given cefazolin antibiotic prophylaxis, stress ulcer prophylaxis, analgesics, and anticoagulation prophylaxis with subcutaneous enoxaparin and warfarin.

Eighty-six patients were included in the final analysis, with 51 (59.3 percent) being vitamin D deficient on hospital admission. Alfacalcidol produced a marked reduction in ICU LOS (hazard ratio [HR], 1.61, 95 percent confidence interval [CI], 1.77–2.81; p=0.041) and hospital LOS (HR, 1.63, 95 percent CI, 1.04–2.55; p=0.034).

Compared with controls, treated patients had much lower postoperative infection rate (35.5 percent vs 56.1 percent; p=0.017) and median epinephrine dose (5.9 vs 8.2 mg; p=0.019).

There was no significant difference in the rate of in-hospital mortality.

The findings suggest that alfacalcidol may be beneficial via its immunomodulatory and cardioprotective properties.