Clinically recommended strategies for nutritional metabolic intervention in cardiac surgery: a narrative review of oral support agents and modulators on postoperative outcomes and mechanisms
TL;DR
The current evidence base does not yet support biomarker-driven or genotype-guided precision supplementation, and future high-quality RCTs are needed to validate the efficacy of these supplements across different patient subsets.
Abstract
Background The burden of postoperative complications following cardiac surgery remains substantial, and nutritional metabolic intervention represents an important adjunctive strategy. Aim To systematically evaluate the evidence base for oral nutritional supplements and their clinical application strategies. Methods A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2026. Randomized controlled trials (RCTs), meta-analyses, and systematic reviews on the perioperative use of nutritional supplements in cardiac surgery were included. Results A total of 89 relevant studies were identified and synthesized narratively. Based on the quality of available evidence and clinical benefit, the supplements were categorized as follows: Strongly recommended: magnesium; Recommended: L-carnitine; Moderate/promising support: coenzyme Q10, vitamin C, melatonin, D-ribose, citrulline, glutamine; Not recommended/insufficient evidence: creatine/phosphocreatine, taurine, thiamine, vitamin D (unless baseline deficiency), dietary nitrates, N-acetylcysteine; Emerging/experimental (pending evaluation): NAD + precursors, PQQ, astaxanthin, quercetin, curcumin, carnosine, ergothioneine; Use with caution/contraindicated: ginseng, red yeast rice, probiotics (in specific populations). Conclusion Magnesium should be considered a routine adjunctive therapy, while L-carnitine and coenzyme Q10 are recommended supplements. Individualized selection is critical, requiring consideration of patient characteristics, surgical type, and baseline status. However, it should be noted that the current evidence base does not yet support biomarker-driven or genotype-guided precision supplementation; future high-quality RCTs are needed to validate the efficacy of these supplements across different patient subsets. The translational gap from preclinical studies to clinical application should be carefully addressed, and more high-quality RCTs are needed to validate the efficacy of emerging supplements.