Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression

Valerie A. Schroeder, Jeffery M. Pearl, Steven M. Schwartz, Thomas P. Shanley, Peter B. Manning, David P. Nelson

Research output: Contribution to journalArticle

123 Scopus citations

Abstract

Background - Steroid administration during cardiopulmonary bypass is thought to improve cardiopulmonary function by modulating bypass-related inflammation. This study was designed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome. Methods and Results - Twenty-nine pediatric patients undergoing bypass procedures were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg 4 hours before bypass and in bypass prime, n = 14) or intraoperative MP only (30 mg/kg, n = 15). Myocardial inflammatory mediator mRNA expression was determined in paired atrial biopsies (before and after bypass) by ribonuclease protection. Before and after bypass, serum IL-6 and IL-10 were measured by ELISA. Postoperative outcome was assessed by intubation time, CICU length of stay, fluid balance, arterio-venous O2 difference (ΔA-VO2), and inotrope requirements. Compared with intraoperative MP alone, combined preoperative and intraoperative MP was associated with reduced myocardial mRNA expression for IL-6, MCP-1, and ICAM-1 both before and after bypass (P<0.05). Patients who received combined steroids had lower serum IL-6 and increased IL-10 at end-bypass (P<0.05), although differences were negligible by 24 hours. Combined MP treatment was associated with reduced fluid requirements, lower body temperature, and lower ΔA-VO2 for the first 24 hours after surgery (P<0.05), along with trends toward improvement in other clinical outcomes. Conclusions - Compared with intraoperative steroid treatment, combined preoperative and intraoperative steroid administration attenuates inflammatory mediator expression more effectively and is associated with improved indexes of O2 delivery in the first 24 hours after congenital heart surgery. These findings need to be confirmed in a larger multicenter trial.

Original languageEnglish
Pages (from-to)2823-2828
Number of pages6
JournalCirculation
Volume107
Issue number22
DOIs
StatePublished - Jun 10 2003

Keywords

  • Cardiopulmonary bypass
  • Heart defects, congenital
  • Inflammation
  • Interleukins

Fingerprint Dive into the research topics of 'Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression'. Together they form a unique fingerprint.

  • Cite this