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J Thorac Cardiovasc Surg 2001;122:1052
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Inflammatory response associated with cardiopulmonary bypass and effect of methylprednisolone

Pierre J. Corbi, MD, Mohammad Rahmati, MD

Cardio-Thoracic Unit
Poitiers Hospital
Poitiers, France

Jean-Claude Lecron, PhD

Cytokine Group
ESA CNRS 6021, IBMIG
University of Poitiers
Poitiers, France

To the Editor:

We read with interest the article by Chaney and associates.Go 1 The study was well designed to evaluate the effect of corticosteroids in patients undergoing coronary artery bypass grafting. The authors concluded that methylprednisolone offers no clinical benefit and may in fact be detrimental.
Chaney and associates used methylprednisolone to reduce the systemic inflammatory response associated with cardiopulmonary bypass (CPB), especially for circulating levels of cytokines (interleukins 6 and 8). Other authors have suggested that the increase of cytokines is an inflammatory response related to CPB, but many factors have been assumed to lead to this systemic inflammatory response: surgical trauma, ischemia-reperfusion injury, reinfusion of shed blood, hemodilution, and protamine-heparin complexes. Off-pump coronary surgery provides a model to evaluate the role of CPB in inflammatory responses after coronary surgery.
Several authors and our team have studied the release of cytokines in 2 groups of patients undergoing grafting, with or without CPB. These studies suggested that cytokine is mainly a reaction to surgical trauma rather than to CPB.Go Go 2,3 Corticosteroids are not a common perioperative treatment. The only reason to use corticosteroid therapy in cardiac surgery is to avoid the adverse effects of CPB, which presumably are caused by the activation of cytokines. We believe that the real importance of CPB has not yet been determined. According to these findings, the indication for and effectiveness of methylprednisolone in cardiac surgery should be discussed. In fact, the absence of clinical effectiveness of this treatment in cardiac surgery could be an additional argument to reconsider the role of CPB in activation of inflammatory mediators after coronary artery bypass grafting.
12/8/118501
doi:10.1067/mtc.2001.118501

References

  1. Chaney MA, Durazo-Arzivu RA, Nikolov MP, Blakeman BP, Bakhos M. Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early extubation. J Thorac Cardiovasc Surg. 2001;121:561-69.[Abstract/Free Full Text]
  2. Fransen E, Maessen J, Dentener M, Senden N, Geskes G, Buurman W. Systemic inflammation in patients undergoing CABG without extracorporeal circulation. Chest. 1998;113:1290-5.[Abstract/Free Full Text]
  3. Corbi P, Rahmati M, Delwail A, Potreau D, Menu P, Wijdenes J, et al. Circulating soluble gp130, soluble IL-6R, and IL-6 in patients undergoing cardiac surgery, with or without extracorporeal circulation. Eur J Cardiothorac Surg. 2000;18:98-103.[Abstract/Free Full Text]




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