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

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 31; no. 6; pp. 1952 - 1956
• Main Authors: Pesonen, Eero, Keski-Nisula, Juho, Passov, Arie, Vähätalo, Raisa, Puntila, Juha, Andersson, Sture, Suominen, Pertti K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017
• Subjects: Administration, Intravenous; Anti-Inflammatory Agents - administration & dosage; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Child; Double-Blind Method; Fatty Acid Binding Protein 3 - blood; Fatty Acid-Binding Proteins - blood; Female; Heart Septal Defects - blood; Heart Septal Defects - surgery; heart-type fatty-acid-binding protein; Humans; Infant; Infant, Newborn; Intraoperative Complications - blood; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Male; methylprednisolone; Methylprednisolone - administration & dosage; reperfusion; troponin; methylprednisolone; troponin; heart-type fatty-acid-binding protein; reperfusion
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2017.05.013

Corticosteroids possess cardioprotection in experimental cardiac ischemia/reperfusion. The authors hypothesized that if cardioprotection of corticosteroids occured during pediatric cardiac surgery, then methylprednisolone used in cardiopulmonary bypass prime would reduce postoperative concentrations of heart-type fatty-acid-binding protein, a cardiac biomarker. A double-blind, placebo-controlled, randomized clinical trial. Operating room and pediatric intensive care unit of a university hospital. Forty-five infants and young children undergoing ventricular or atrioventricular septal defect correction. The patients received one of the following: 30 mg/kg of methylprednisolone intravenously after anesthesia induction (n = 15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime solution (n = 15), or placebo (n = 15). Plasma heart-type fatty-acid-binding protein (hFABP) was measured. Preoperatively, hFABP did not differ among the study groups. Methylprednisolone administered preoperatively and in the cardiopulmonary bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033) 6 hours postoperatively. hFABP significantly correlated with concomitant troponin T after protamine administration (R = 0.811, p < 0.001) and 6 hours postoperatively (R = 0.806, p < 0.001). Methylprednisolone in cardiopulmonary bypass prime solution administered only a few minutes before cardiac ischemia confered cardioprotection of the same magnitude as preoperative methylprednisolone as indicated by hFABP concentrations. Rapid cardioprotective actions of corticosteroids in pediatric heart surgery observed previously experimentally may have occurred.