Dexamethasone Pretreatment Provides Antiinflammatory and Myocardial Protection in Neonatal Arterial Switch Operation

• Published in: The Annals of thoracic surgery Vol. 93; no. 3; pp. 869 - 876
• Main Authors: Heying, Ruth, MD, PhD, Wehage, Edith, PhD, Schumacher, Katharina, MD, Tassani, Peter, MD, PhD, Haas, Felix, MD, PhD, Lange, Rudiger, MD, PhD, Hess, John, MD, PhD, Seghaye, Marie-Christine, MD, PhD
• Format: Journal Article Web Resource
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Cardiac Surgical Procedures - methods; Cardiology. Vascular system; Cardiomyopathies - prevention & control; Cardiopulmonary Bypass; Cardiothoracic Surgery; Cytokines - blood; Dexamethasone - therapeutic use; Double-Blind Method; Human health sciences; Humans; Infant, Newborn; Inflammation - prevention & control; Medical sciences; Pediatrics; Pneumology; Postoperative Complications - prevention & control; Preoperative Care; Prospective Studies; Pédiatrie; Sciences de la santé humaine; Surgery; Transposition of Great Vessels - blood; Transposition of Great Vessels - surgery; Transposition of Great Vessels/blood/surgery; 21; Human; Corticosteroid; Neonatal; Dexamethasone; Steroid hormone; Antiinflammatory agent; Operation; Newborn; Treatment; Surgery; Myocardium; Anesthesia; Circulatory system; Pretreatment; Cardiology; Protection
• ISSN: 0003-4975; 1552-6259; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.11.059

Background This prospective double-blinded randomized study tested the hypothesis that preoperative treatment with dexamethasone would attenuate inflammatory priming of the myocardium, reduce the systemic inflammatory reaction upon cardiac operation, and provide organ protection in neonates. Methods Twenty neonates (age, 8 to 21 days) with transposition of the great arteries scheduled for arterial switch operation were included. Nine received dexamethasone (1 mg/kg body weight) 4 hours before cardiopulmonary bypass, and 11 received natrium chloride. We studied intramyocardial messenger RNA expression of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor-α (TNF-α), as well as IL-10 and expression of TNF-α on protein level in right atrial tissue taken before institution of CPB. We measured plasma levels of IL-6, IL-10, lipopolysaccharide binding protein, and cardiac troponin T. Cytokine expression was related to postoperative outcome. Results Pretreatment with dexamethasone led to a significant decrease in myocardial expression of IL-6, IL-8, IL-1β, and TNF-α messenger RNA and to a decrease in protein synthesis of TNF-α. Plasma concentrations of IL-6 were significantly lower and those of IL-10 significantly higher in pretreated patients. This was associated with lower cardiac troponin T values and lower dobutamine requirement. Levels of lipopolysaccharide binding protein were significantly higher postoperatively in pretreated neonates. Conclusions Dexamethasone administration before arterial switch operation leads to a shift in the myocardial and systemic cytokine expression profile in neonates with transposition of the great arteries, with downregulation of proinflammatory and upregulation of antiinflammatory cytokines. Lower myocardial cell damage and lower catecholamine requirement suggest myocardial protection in treated patients.