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Related Experiment Video

Updated: Jul 16, 2026

Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft

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Does coronary artery bypass surgery affect metoprolol bioavailability.

Antti Valtola¹, Hannu Kokki, Merja Gergov

¹Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland.

European Journal of Clinical Pharmacology

|March 3, 2007

Summary

Metoprolol bioavailability is significantly reduced in patients during the early period after coronary artery bypass surgery (CABG). This reduced absorption may explain why beta-blockers are less effective at preventing postoperative atrial fibrillation (AF).

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Published on: March 27, 2018

Area of Science:

Pharmacokinetics
Cardiovascular Surgery
Cardiac Electrophysiology

Background:

Beta-blockers are standard care for patients undergoing coronary artery bypass surgery (CABG).
Postoperative atrial fibrillation (AF) remains common (9-19%) despite beta-blocker use.
The reason for the limited efficacy of beta-blockers in preventing AF post-CABG is unclear.

Purpose of the Study:

To evaluate the bioavailability of perioperative metoprolol tablets in patients undergoing CABG surgery.
To investigate the pharmacokinetic profile of metoprolol in the early postoperative period following CABG.

Main Methods:

A pharmacokinetic study involving 12 male patients (45-64 years) scheduled for CABG.
Patients received oral metoprolol tartrate 50 mg preoperatively and every 12 hours.
Plasma metoprolol concentrations were analyzed using liquid chromatography-tandem mass spectrometry on preoperative, postoperative day 1, and postoperative day 3.

Main Results:

Metoprolol bioavailability, measured by AUC(0-12), was significantly lower on postoperative day 1 compared to the preoperative day.
Peak plasma concentrations (Cmax) also showed a marked reduction on postoperative day 1.
Bioavailability returned to preoperative levels by postoperative day 3; one patient with low metoprolol absorption developed AF.

Conclusions:

Metoprolol bioavailability is substantially reduced in the early phase after CABG when administered in tablet form.
This diminished bioavailability may contribute to the high incidence of postoperative atrial fibrillation.