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Heart-Type Fatty Acid Binding Protein and High-Dose Methylprednisolone in Pediatric Cardiac Surgery

Eero Pesonen1, Juho Keski-Nisula2, Arie Passov1

  • 1Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Journal of Cardiothoracic and Vascular Anesthesia
|October 26, 2017
PubMed

Insights

Methylprednisolone in cardiopulmonary bypass prime reduced cardiac biomarker concentrations in pediatric heart surgery patients. This corticosteroid intervention demonstrated cardioprotection similar to preoperative administration.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Pharmacology

Background:

  • Corticosteroids have shown cardioprotective effects in experimental models of cardiac ischemia/reperfusion.
  • The potential cardioprotective role of corticosteroids during pediatric cardiac surgery requires further investigation.

Purpose of the Study:

  • To investigate the cardioprotective efficacy of methylprednisolone in pediatric cardiac surgery.
  • To determine if methylprednisolone administered during cardiopulmonary bypass reduces postoperative cardiac biomarker levels.

Main Methods:

  • A double-blind, placebo-controlled, randomized clinical trial was conducted.
  • Forty-five pediatric patients undergoing septal defect correction received either methylprednisolone (preoperatively or in bypass prime) or placebo.
  • Plasma heart-type fatty-acid-binding protein (hFABP) was measured as a cardiac biomarker.

Main Results:

  • Both preoperative methylprednisolone and methylprednisolone in bypass prime significantly reduced hFABP concentrations 6 hours postoperatively (44% and 38% reduction, respectively).
  • No significant difference in hFABP was observed preoperatively among the groups.
  • hFABP showed a strong correlation with troponin T postoperatively.

Conclusions:

  • Methylprednisolone administered in cardiopulmonary bypass prime solution provides cardioprotection comparable to preoperative administration in pediatric heart surgery.
  • The rapid cardioprotective effects of corticosteroids observed experimentally may be relevant in clinical pediatric cardiac surgery.
  • Methylprednisolone is a potential therapeutic agent for reducing myocardial injury during pediatric cardiac procedures.
Abstract

Keywords:
heart-type fatty-acid-binding proteinmethylprednisolonereperfusiontroponin

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