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Volume 3 Supplement 2

International Symposium on the Pathophysiology of Cardiopulmonary Bypass

Corticosteroids reduce early troponin-T release after cardiac surgery with cardiopulmonary bypass in men

Objectives

To study whether administration of corticosteroids (CS) prior to cardiac surgery for coronary artery bypass grafting (CABG), can influence early troponin-T release after cardiac surgery with cardiopulmonary bypass (CPB).

Material and methods

Fifty-eight male patients with coronary artery disease undergoing programmed CABG with CPB were divided into five groups: Group 1 (Control; n = 10); Group 2 (methylprednisolone, (MPS) = 10 mg/kg, 4 h before CPB; n = 14); Group 3 (MPS = 10 mg/kg, at induction of anesthesia (IA); n = 10); Group 4 (MPS = 10 mg/kg, 12h before, as well as at IA; n = 10); Group 5 (MPS = 30 mg/kg 4 h before CPB; n = 14). CPB was conducted using a blood-free priming, a cold crystalloid cardioplegia and moderate hypothermia (29-30°C). Anesthesia consisted of continuous administration of midazolam, sufentanil and pancuronium. Aprotinin was not used. Plasmatic troponin-T levels were measured before induction of anesthesia (t0) and 4 h after CPB (t1) using specific ELISA.

Results

There was no significant difference in age, weight, duration of CPB, aorta clamping time and number of grafts between groups (Table). Troponin-T values at t0 were similar in all patients. Troponin-T levels measured 4h after the end of CPB were similar in control (Group 1), Group 3, and Group 4. In contrast, troponin-T levels were significantly lower in the 2 groups receiving MPS 4h before CPB (Group 2: 10 mg/kg and Group 5: 30 mg/kg) as compared to controls (*P = 0.001 and **P = 0.0004, respectively). There was no significant difference in troponin-T levels between Group 2 and Group 5.

Table 1

Conclusion

Pharmacological doses of CS significantly reduce early troponin-T release after CPB. The timing of CS administration plays an important role, as the treatment was effective when CS were given 4 h prior to CPB but not at the beginning of surgery. Doses of 10 mg/kg and 30 mg/kg are equally effective.

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Tabardel, Y., Schmartz, D., Leclerc, J. et al. Corticosteroids reduce early troponin-T release after cardiac surgery with cardiopulmonary bypass in men. Crit Care 3, P27 (1999). https://doi.org/10.1186/cc338

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Keywords

  • Coronary Artery Disease
  • Corticosteroid
  • Cardiac Surgery
  • Male Patient
  • Emergency Medicine