| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2005;79:655-665
© 2005 The Society of Thoracic Surgeons
a Division of Cardiac Surgery
b Division of Cardiac Anaesthesia
c Division of Surgery
d Division of Clinical Research
e Division of Rheumatology
f Division of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
Accepted for publication July 19, 2004.
* Address reprint requests to Dr Rubens, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario K1Y 4W7, Canada (E-mail: frubens{at}ottawaheart.ca).
BACKGROUND: Cardiopulmonary bypass (CPB) induces derangements in physiology characterized by activation of blood pathways that may contribute to multiorgan dysfunction. This trial addresses the efficacy of a biocompatible surface alone and in combination with steroids in inhibiting these changes.
METHODS: In a factorial design, patients undergoing coronary artery bypass grafting were randomized (four groups; n = 17 per group) to CPB utilizing control circuits or a circuit prepared with a surface modifying active copolymer (SMA-CPB), with or without methylprednisolone (MPSS, 1 g intravenous). Leukocyte and complement activation, cytokine release, and bradykinin generation were measured. Clinical outcomes (blood loss, transfusion, arterial pressure response, and postoperative cardiac and pulmonary functions) were also examined.
RESULTS: The SMA-CPB was associated with a significant inhibition of elastase release (p = 0.026) and bradykinin generation (p = 0.027) during CPB. Terminal complement complex (TCC) generation was inhibited as an effect of SMA-CPB (p = 0.047). There was an interaction of SMA-CPB and MPSS to decrease both TCC (p = 0.042) and bradykinin generation (p = 0.028). There were strong effects of MPSS in inhibiting release of interleukin 6 (IL-6) (p = 0.007) and IL-8 (p < 0.001) and tissue plasminogen activator over time (p = 0.009) as well as decreasing peak day 1 creatine kinase (CK, p = 0.015) levels. Clinical effects of MPSS included decreased atrial fibrillation (p = 0.02), improved cardiac index over time, increased pulmonary compliance, and increased insulin need.
CONCLUSIONS: This trial suggests a potential beneficial effect for combined strategies to minimize inflammation after CPB. The specific effect of MPSS in decreasing postoperative atrial fibrillation and CK warrants further investigation of its role as a potential myocardial protective agent.
This article has been cited by other articles:
|
|
 |
|
  J. Price, R. Tee, B.-K. Lam, P. Hendry, M. S. Green, and F. D. Rubens Current use of prophylactic strategies for postoperative atrial fibrillation: a survey of Canadian cardiac surgeons. Ann. Thorac. Surg., July 1, 2009; 88(1): 106 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Anselmi, G. Possati, and M. Gaudino Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation? Ann. Thorac. Surg., July 1, 2009; 88(1): 326 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Ho and J. A. Tan Benefits and Risks of Corticosteroid Prophylaxis in Adult Cardiac Surgery: A Dose-Response Meta-Analysis Circulation, April 14, 2009; 119(14): 1853 - 1866. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kaireviciute, A. Aidietis, and G. Y.H. Lip Atrial fibrillation following cardiac surgery: clinical features and preventative strategies Eur. Heart J., February 2, 2009; 30(4): 410 - 425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Senay, F. Toraman, S. Gunaydin, M. Kilercik, H. Karabulut, and C. Alhan The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study Interactive CardioVascular and Thoracic Surgery, January 1, 2009; 8(1): 93 - 99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. P. Whitlock, S. Chan, P.J. Devereaux, J. Sun, F. D. Rubens, K. Thorlund, and K. H.T. Teoh Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials Eur. Heart J., November 1, 2008; 29(21): 2592 - 2600. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Levionnois and P. Kronen Development of post-pump syndrome in a sheep after mitral valve stenting Lab Anim, October 1, 2008; 42(4): 505 - 510. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Dorian and B. N. Singh Upstream therapies to prevent atrial fibrillation Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H11 - H31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Halonen, P. Halonen, O. Jarvinen, P. Taskinen, T. Auvinen, M. Tarkka, M. Hippelainen, T. Juvonen, J. Hartikainen, and T. Hakala Corticosteroids for the Prevention of Atrial Fibrillation After Cardiac Surgery: A Randomized Controlled Trial JAMA, April 11, 2007; 297(14): 1562 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Wakayama, I. Fukuda, Y. Suzuki, and N. Kondo Neutrophil Elastase Inhibitor, Sivelestat, Attenuates Acute Lung Injury After Cardiopulmonary Bypass in the Rabbit Endotoxemia Model Ann. Thorac. Surg., January 1, 2007; 83(1): 153 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Ishida, F. Kimura, M. Imamaki, A. Ishida, H. Shimura, H. Kohno, M. Sakurai, and M. Miyazaki Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 501 - 505. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
