Clinical benefits of methylprednisolone in off-pump coronary artery bypass
surgery.
Author(s): Suezawa T(1), Aoki A, Kotani M, Tago M, Kobayashi O, Hirasaki A, Sano M, Kameda
N, Mitsunaka H.
Affiliation(s): Author information:
(1)Department of Cardiovascular Surgery, Kagawa Prefectural Central Hospital, 5-4-16
Ban-cho, Takamatsu, Kagawa 760-8557, Japan. suezawa2004@yahoo.co.jp
Publication date & source: 2013, Gen Thorac Cardiovasc Surg. , 61(8):455-9
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.
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