Advertisement

General Thoracic and Cardiovascular Surgery

, Volume 61, Issue 8, pp 455–459 | Cite as

Clinical benefits of methylprednisolone in off-pump coronary artery bypass surgery

  • Takanori SuezawaEmail author
  • Atsushi Aoki
  • Mitsuhisa Kotani
  • Mamoru Tago
  • Osamu Kobayashi
  • Akihito Hirasaki
  • Minako Sano
  • Nana Kameda
  • Hiroki Mitsunaka
Original Article

Abstract

Background

It has not been established whether off-pump coronary artery bypass grafting (OPCABG) is less invasive than conventional CABG. In our experience, OPCABG has several advantages such as shorter operative duration, decreased requirement of blood transfusion and myocardial protection compared with conventional CABG. However, frequency of postoperative paroxysmal atrial fibrillation (PAF) is similar between these techniques and early postoperative C-reactive protein (CRP) levels have been shown to be significantly higher in OPCABG. We hypothesized that preoperative steroid administration, routinely used only in conventional CABG, may alleviate high postoperative PAF and CRP levels. Therefore, a prospective, double-blind, clinical trial was conducted in OPCABG patients to investigate the clinical effects of preoperative steroid administration.

Methods

Thirty OPCABG patients were randomly divided into 2 groups: control (Group C: n = 15) and methylprednisolone (Group M: n = 15) groups. Group M patients were intravenously administered 1000 mg methylprednisolone during anesthesia induction.

Results

Hospital death and infectious complication such as mediastinitis were not observed in either group. Postoperative PAF occurred in 47 % (7/15) of patients in group C but in only 1 patient in group M (7 %, P = 0.013). Early postoperative CRP levels were significantly lower in group M than in group C (peak values on postoperative day 2: group M 15 ± 6 mg/dL vs. group C 23 ± 4 mg/dL; P = 0.0002).

Conclusions

Preoperative steroid administration in OPCABG patients significantly suppresses CRP elevation and prevents postoperative PAF without increasing in-hospital mortality or infectious complications.

Keywords

Off-pump coronary artery bypass Methylprednisolone Atrial fibrillation Inflammation 

Notes

Acknowledgments

The authors thank Drs. Rikiya Matsuda, Akihiro Nagai, Sawako Takebe, Yuichi Yatsu, Kazuyoshi Inoue, Masaharu Nagae and Shinkichi Otani for collection of data.

References

  1. 1.
    Kouchoukos NT, Blackstone EH, Doty DB. Stenotic atherosclerotic coronary artery disease. In: Kirklin, Barratt-Boyes, editors. Cardiac surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2003. p. 353–453.Google Scholar
  2. 2.
    Jansen EW. Options for off-pump coronary revascularization. In: Gardner TJ, Spray TL, editors. Operative cardiac surgery. 5th ed. London: Arnold; 2004. p. 134–52.CrossRefGoogle Scholar
  3. 3.
    Archbold RA, Curzen NP. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart. 2003;89:1134–7.CrossRefGoogle Scholar
  4. 4.
    Ascione R, Caputo M, Calori G, Lloyd CT, Underwood MJ, Angelini GD. Predictors of atrial fibrillation after conventional and beating heart coronary surgery: a prospective, randomized study. Circulation. 2000;102:1530–5.CrossRefGoogle Scholar
  5. 5.
    Hayashida N, Teshima H, Chihara S, Tomoeda H, Takaseya T, Hiratsuka R, et al. Does off-pump coronary artery bypass grafting really preserve renal function? Circ J. 2002;66:921–5.CrossRefGoogle Scholar
  6. 6.
    Lo B, Fijnheer R, Nierich AP, Bruins P, Kalkman CJ. C-reactive protein is a risk indicator for atrial fibrillation after myocardial revascularization. Ann Thorac Surg. 2005;79:1530–5.CrossRefGoogle Scholar
  7. 7.
    Ziabakhsh TS. Can perioperative C-reactive protein and interleukin-6 levels predict atrial fibrillation after coronary artery bypass surgery? Saudi Med J. 2008;29:1429–31.Google Scholar
  8. 8.
    Kaireviciute D, Blann AD, Balakrishnan B, Lane DA, Patel JV, Uzdavinys G, et al. Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients. Thromb Haemost. 2010;104:122–7.CrossRefGoogle Scholar
  9. 9.
    Choi YS, Shim JK, Hong SW, Kimc DH, Kima JC, Kwak YL. Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement. Eur J Cardiovasc Surg. 2009;36:838–43.CrossRefGoogle Scholar
  10. 10.
    Ishida K, Kimura F, Imamaki M, Ishida A, Shimura H, Kohno H, et al. Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur J Cardiovasc Surg. 2006;29:501–5.CrossRefGoogle Scholar
  11. 11.
    Ucar HI, Tok M, Atalar E, Dogan OF, Oc M, Farsak B, et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum. 2007;10:E131–5.CrossRefGoogle Scholar
  12. 12.
    Suezawa T, Aoki A, Kotani M, Tago M. Operative invasiveness of off-pump coronary artery bypass grafting. Kyobu geka. 2012;65:1031–5.PubMedGoogle Scholar
  13. 13.
    Kawata T, Ueda T, Taniguchi S. Feasible pericardiotomy for off-pump coronary artery bypass. Ann Thorac Cardiovasc Surg. 2003;9:279–80.PubMedGoogle Scholar
  14. 14.
    Yamashita Y, Shimada M, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, et al. Effects of preoperative steroid administration on surgical stress in hepatic resection. Prospective randomized trial. Arch Surg. 2001;136:328–33.CrossRefGoogle Scholar
  15. 15.
    Shimada H, Ochiai T, Okazumi S, Matsubara H, Nabeya Y, Miyazawa Y, et al. Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer. Surgery. 2000;128:791–8.CrossRefGoogle Scholar
  16. 16.
    Kirdak T, Yilmazlar A, Cavun S, Ercan I, Yilmazlar T. Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg. 2008;74:160–7.PubMedGoogle Scholar
  17. 17.
    Liakopoulos OJ, Schmitto JD, Kazmaier S, Brauer A, Quintel M, Schoendube FA, et al. Cardiopulmonary and systemic effects of methylprednisolone in patients undergoing cardiac surgery. Ann Thorac Surg. 2007;84:110–9.CrossRefGoogle Scholar
  18. 18.
    Mayumi H, Zhang QW, Nakashima A, Masuda M, Kohno H, Kawachi Y, et al. Synergistic immunosuppression caused by high-dose methylprednisolone and cardiopulmonary bypass. Ann Thorac Surg. 1997;63:129–37.CrossRefGoogle Scholar
  19. 19.
    Schurr UP, Zund G, Hoerstrup SP, Grunenfelder J, Maly FE, Vogt PR, et al. Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass. Ann Thorac Surg. 2001;72:1316–20.CrossRefGoogle Scholar
  20. 20.
    Morariu AM, Loef BG, Aarts LPHJ, Rietman GW, Rakhorst G, Oeveren W, et al. Dexamethasone: benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting. A study on myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest. 2005;128:2677–87.CrossRefGoogle Scholar
  21. 21.
    Volk T, Schmutzler M, Engelhardt L, Docke WD, Volk HD, Konertz W, et al. Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass. Crit Care Med. 2001;29:2137–42.CrossRefGoogle Scholar
  22. 22.
    Komori K, Ishida M, Matsumoto T, Kumw M, Ohta S. Cytokine patterns and the effects of a preoperative steroid treatment in the patients with abdominal aortic aneurysms. Int Angiol. 1999;18:193–7.PubMedGoogle Scholar
  23. 23.
    Shimidt SC, Hamann S, Langrehr JM, Hoflich C, Mittler J, Jacob D, et al. Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. J Hepatobiliary Pancreat Surg. 2007;14:484–92.CrossRefGoogle Scholar
  24. 24.
    Yano M, Taniguchi T, Tsujinaka T, Fujiwara Y, Yasuda T, Shiozaki H, et al. Is preoperative methylprednisolone beneficial for patients undergoing esophagectomy? Hepatogastroenterology. 2005;52:481–5.PubMedGoogle Scholar
  25. 25.
    Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11:954–63.CrossRefGoogle Scholar
  26. 26.
    Ginzler E, Diamond H, Kaplan D, Weiner M, Schlesinger M, Seleznick M. Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis Rheum. 1978;21:37–44.CrossRefGoogle Scholar
  27. 27.
    Fauci AS, Dale DC, Balow JE. Glucocorticosteroid therapy: mechanism of action and clinical considerations. Ann Int Med. 1976;84:304–15.CrossRefGoogle Scholar
  28. 28.
    MacGregor RR. Inhibition of granulocyte adherence by ethanol, prednisone and aspirin measured in an assay system. N Engl J Med. 1974;291:642–6.CrossRefGoogle Scholar
  29. 29.
    Shezen E. Opposing effects of dexamethasone on the clonal growth of granulocyte and macrophage progenitor cells and on the phagocytic capability of mononuclear phagocytes at difficult stages of differentiation. J Cell Physiol. 1985;124:545–8.CrossRefGoogle Scholar
  30. 30.
    Cox G. Glucocorticoid treatment inhibits apoptosis in human neutrophils: separation of survival and activation outcomes. J Immunol. 1995;154:4719–25.PubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2013

Authors and Affiliations

  • Takanori Suezawa
    • 1
    Email author
  • Atsushi Aoki
    • 1
  • Mitsuhisa Kotani
    • 1
  • Mamoru Tago
    • 1
  • Osamu Kobayashi
    • 2
  • Akihito Hirasaki
    • 2
  • Minako Sano
    • 2
  • Nana Kameda
    • 2
  • Hiroki Mitsunaka
    • 3
  1. 1.Department of Cardiovascular SurgeryKagawa Prefectural Central HospitalTakamatsuJapan
  2. 2.Department of AnesthesiologyKagawa Prefectural Central HospitalTakamatsuJapan
  3. 3.Department of RheumatologyKagawa Prefectural Central HospitalTakamatsuJapan

Personalised recommendations