Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

Demir, Tolga; Ergenoglu, Mehmet Umit; Demir, Hatice; Tanrikulu, Nursen; Şahın, Mazlum; Gok, Emre; Korkut, Kubilay; Demirsoy, Ergün

doi:10.1532/hsf.1367

Cited by 6 publications

(4 citation statements)

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“…A previous systematic review and meta-analysis published in 2011 found that corticosteroids were not associated with any significant reduction in clinically important adverse outcomes from heart surgery [19]. Since that review was published, 8 randomized controlled trials (RCTs) including 2 trials [20,21] with large population sample sizes have been published [20][21][22][23][24][25][26][27]. Thus, an updated systematic review and meta-analysis is warranted to summarize the current understanding of the use of corticosteroids in patients undergoing heart surgery with CPB.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials

Paassen

Langan

et al. 2020

European Journal of Cardio-Thoracic Surgery

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Corticosteroids are often administered prophylactically to attenuate the inflammatory response associated with cardiac surgery using cardiopulmonary bypass (CPB). However, the efficacy and safety profile of corticosteroids remain uncertain. The primary aim of this systematic review and meta-analysis was to investigate the effect of corticosteroids on mortality in adult cardiac surgery using CPB. Secondary aims were to examine the effect of corticosteroids on myocardial adverse events, pulmonary adverse events, atrial fibrillation, surgical site infection, gastrointestinal bleeding and duration of stay in the intensive care unit and hospital. Randomized controlled trials (RCTs) were systematically searched in electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science) from their inception until March 2019. Observational studies, case reports, case series and literature reviews were excluded. Sixty-two studies (n = 16 457 patients) were included in this meta-analysis. There was no significant difference in mortality between the corticosteroid and placebo groups [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.81–1.14; P = 0.65, participants = 14 693, studies = 24, evidence of certainty: moderate]. Compared to those receiving a placebo, patients who were given corticosteroids had a significantly higher incidence of myocardial adverse events (OR 1.17, 95% CI 1.03–1.33; P = 0.01, participants = 14 512, studies = 23) and a lower incidence of pulmonary adverse events (OR 0.86, 95% CI 0.75–0.98; P = 0.02, participants = 13 426, studies = 17). The incidences of atrial fibrillation (OR 0.87, 95% CI 0.81–0.94; P < 0.001, participants = 14 148, studies = 24) and surgical site infection (OR 0.81, 95% CI 0.73–0.90; P < 0.001, participants = 13 946; studies = 22) were all lower in patients who were given corticosteroids. In the present meta-analysis of 62 RCTs (16 457 patients), including the 2 major RCTs (SIRS and DECS trials: 12 001 patients), we found that prophylactic corticosteroids in cardiac surgery did not reduce mortality. The clinical significance of an increase in myocardial adverse events remains unclear as the definition of a relevant myocardial end point following cardiac surgery varied greatly between RCTs.

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Section: Introductionmentioning

confidence: 99%

The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials

Paassen

Langan

et al. 2020

European Journal of Cardio-Thoracic Surgery

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“…The prophylactic administration of steroid, with the aim of improving the post-operative patient outcomes in surgeries involving CPB, has shown mixed results in clinical trials Supplementary Table 2. Multiple studies have found that corticosteroid-related attenuation of the inflammation and tissue injury and oxidative stress, is associated with improvement of post-operative contractile function of the heart, lower incidence of post-operative atrial fibrillation (AF), decreased requirement for ventilator and circulatory support, and shorter length of hospital and ICU stay without increasing the risk of infections (171)(172)(173)(174)(175)(176)(177)(178)(179)(180). Still, some other studies have not detected any beneficial effects for corticosteroid administration in improving post-operative primary and secondary outcomes (173)(174)(175)(176)180).…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Multiple studies have found that corticosteroid-related attenuation of the inflammation and tissue injury and oxidative stress, is associated with improvement of post-operative contractile function of the heart, lower incidence of post-operative atrial fibrillation (AF), decreased requirement for ventilator and circulatory support, and shorter length of hospital and ICU stay without increasing the risk of infections (171)(172)(173)(174)(175)(176)(177)(178)(179)(180). Still, some other studies have not detected any beneficial effects for corticosteroid administration in improving post-operative primary and secondary outcomes (173)(174)(175)(176)180). Despite the mixed findings, meta-analytical studies suggests that prophylactic corticosteroids in patients undergoing cardiac surgery involving CPB significantly decreases the length of stay in ICU and hospital and incidence of post-operation AF in both adult and pediatric patient populations, and decreased inflammation has been suggested to be one of the key element in these effects (181)(182)(183).…”

Section: Corticosteroidsmentioning

confidence: 99%

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

2022

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Extracorporeal circulation (ECC) systems, including cardiopulmonary bypass, and extracorporeal membrane oxygenation have been an irreplaceable part of the cardiothoracic surgeries, and treatment of critically ill patients with respiratory and/or cardiac failure for more than half a century. During the recent decades, the concept of extracorporeal circulation has been extended to isolated machine perfusion of the donor organ including thoracic organs (ex-situ organ perfusion, ESOP) as a method for dynamic, semi-physiologic preservation, and potential improvement of the donor organs. The extracorporeal life support systems (ECLS) have been lifesaving and facilitating complex cardiothoracic surgeries, and the ESOP technology has the potential to increase the number of the transplantable donor organs, and to improve the outcomes of transplantation. However, these artificial circulation systems in general have been associated with activation of the inflammatory and oxidative stress responses in patients and/or in the exposed tissues and organs. The activation of these responses can negatively affect patient outcomes in ECLS, and may as well jeopardize the reliability of the organ viability assessment, and the outcomes of thoracic organ preservation and transplantation in ESOP. Both ECLS and ESOP consist of artificial circuit materials and components, which play a key role in the induction of these responses. However, while ECLS can lead to systemic inflammatory and oxidative stress responses negatively affecting various organs/systems of the body, in ESOP, the absence of the organs that play an important role in oxidant scavenging/antioxidative replenishment of the body, such as liver, may make the perfused organ more susceptible to inflammation and oxidative stress during extracorporeal circulation. In the present manuscript, we will review the activation of the inflammatory and oxidative stress responses during ECLP and ESOP, mechanisms involved, clinical implications, and the interventions for attenuating these responses in ECC.

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“…Various pharmacological interventions have been tried to reduce inflammatory responses during on-pump cardiac surgery. [4][5][6] Regional anesthesia with local anesthetics has been shown to inhibit the stress response to surgery and can also influence the postoperative outcome by its beneficial effects on organ function. [7][8][9] In addition to reliable analgesia, intrathecal and epidural anesthesia produce thoracic cardiac sympathectomy and may attenuate stress response in patients undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A Randomized Controlled Study

Kumar

Ghotra

Dwivedi

et al. 2023

World J Pediatr Congenit Heart Surg

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Background: High thoracic epidural analgesia (HTEA) plays a pivotal role in reducing stress and neuroendocrine response in cardiac surgeries. Aim: The primary objective is to assess the effect of HTEA, in pediatric cardiac surgery, on inflammatory markers (interleukin [IL]-6, IL-8, and tumor necrosis factor-α). The secondary objectives are to assess its effect on various organ systems, that is, pulmonary (PaO2, P/F ratio), renal (Creatinine clearance, somatic near infrared spectroscopy [NIRS], serum neutrophil gelatinase–associated lipocalin values), cardiac (cardiac index, serum Trop-I, and lactate levels), mechanical ventilation duration, and length of stay in hospital (LOS). Methods: The study included 188 pediatric patients, who underwent, on-pump cardiac surgery randomized into the Epidural Group (n = 92) and Non-Epidural Group (n = 96). After general anesthesia, a 23 G epidural catheter was placed at the T4-5 level with a Bupivacaine infusion while the Non-epidural Group received fentanyl infusion. Blood samples were collected at four-time points, T0(preop), T1(4 h), and on the first and second postoperative days (T2 and T3). Results: The inflammatory markers were reduced, while the outcomes variables of mechanical ventilation (MV) duration had lower values in the epidural group (19.5 h vs 47.3 h, P = .002). LOS was shorter (10.1 days vs 13.3 days, P = .016). pO2, PF ratio, and renal NIRS values were better in the Epidural Gp, while other parameters were comparable. Non-epidural Gp had more complications esp. Acute kidney injury requires RRT. Conclusion: HTEA use in pediatric, on-pump cardiac surgery offers a favorable profile in terms of reduction in the inflammatory markers and positive effect on the organ systems with lesser MV duration and the LOS.

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Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

Abstract: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.

Cited by 6 publications

References 0 publications

The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials

The efficacy and safety of prophylactic corticosteroids for the prevention of adverse outcomes in patients undergoing heart surgery using cardiopulmonary bypass: a systematic review and meta-analysis of randomized controlled trials

Inflammation and Oxidative Stress in the Context of Extracorporeal Cardiac and Pulmonary Support

Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A Randomized Controlled Study

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