Published Online
on May 19, 2003

A more recent version of this article appeared on June 10, 2003

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Submitted on January 13, 2003
Revised on March 17, 2003
Accepted on March 17, 2003

Combined Steroid Treatment for Congenital Heart Surgery Improves Oxygen Delivery and Reduces Postbypass Inflammatory Mediator Expression

Valerie A. Schroeder MD, MS, Jeffery M. Pearl MD, Steven M. Schwartz MD, Thomas P. Shanley MD, Peter B. Manning MD, and David P. Nelson MD, PhD^*

From the Divisions of Cardiology (V.A.S., S.M.S., D.P.N.), Cardiothoracic Surgery (J.M.P., P.B.M.), Molecular Cardiovascular Biology (S.M.S., D.P.N.), and Critical Care Medicine (T.P.S.), Cincinnati Children's Hospital, Cincinnati, Ohio.

^* To whom correspondence should be addressed. E-mail: Dave.nelson{at}cchmc.org.

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 (A-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 A-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.

Key words: cardiopulmonary bypass • heart defects, congenital • interleukins • inflammation

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