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


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 (DeltaA-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 DeltaA-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.
Schroeder
Valerie A
VA
Division of Cardiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Pearl
Jeffery M
JM
Schwartz
Steven M
SM
Shanley
Thomas P
TP
Manning
Peter B
PB
Nelson
David P
DP
D001831:Body Temperature / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000032:analysis / Q000097:blood*; D007378:Interleukins / Q000097:blood / Q000235:genetics; D007430:Intraoperative Care; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D010101:Oxygen Consumption / Q000187:drug effects*; D011300:Preoperative Care; D012333:RNA, Messenger / Q000378:metabolism; D016896:Treatment Outcome
D018836:Inflammation Mediators; D007378:Interleukins; D012333:RNA, Messenger; D008775:Methylprednisolone