Methylprednisolone and Endothelial Dysfunction in Cardiac Surgery: A Pilot Randomized Trial

Area of Science:

• Cardiology
• Vascular Surgery
• Anesthesiology

Background:

• Cardiac surgery with cardiopulmonary bypass (CPB) is a model for ischemia-reperfusion injury and endothelial dysfunction.
• Endothelial injury manifests as vasoplegia and microcirculatory disturbances.
• Corticosteroids may offer protective effects against CPB-induced endothelial dysfunction.

Purpose of the Study:

• To evaluate the protective effect of a single methylprednisolone dose on endothelial dysfunction in patients undergoing elective cardiac surgery with CPB.
• To assess the impact of methylprednisolone on flow-mediated dilation (FMD), near-infrared spectroscopy (NIRS StO2), and syndecan-1 levels.

Main Methods:

• A parallel-group, randomized, controlled single-center trial involving 39 patients scheduled for elective cardiac surgery with CPB.
• Patients received either intravenous methylprednisolone or placebo at anesthesia induction.
• Primary outcome: endothelial dysfunction assessed by FMD; secondary outcomes: NIRS StO2, syndecan-1 levels, and their correlations.

Main Results:

• No significant differences in FMD, NIRS StO2, or syndecan-1 levels were observed between the methylprednisolone and placebo groups post-CPB.
• Postoperative FMD measurements also showed no significant difference between the groups.
• A significant correlation was found between FMD alteration severity and syndecan-1 levels (r=0.21, p=0.03).

Conclusions:

• Methylprednisolone did not significantly mitigate CPB-associated endothelial dysfunction markers in this cohort.
• A correlation between syndecan-1 levels and peak arterial dilation suggests a link between glycocalyx damage and vascular reactivity.