• Eero Pesonen, Juho Keski-Nisula, Arie Passov, Raisa Vähätalo, Juha Puntila, Sture Andersson, and Pertti K Suominen.
• Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: eero.pesonen@hus.fi.
• J. Cardiothorac. Vasc. Anesth. 2017 Dec 1; 31 (6): 1952-1956.

ObjectivesCorticosteroids possess cardioprotection in experimental cardiac ischemia/reperfusion. The authors hypothesized that if cardioprotection of corticosteroids occured during pediatric cardiac surgery, then methylprednisolone used in cardiopulmonary bypass prime would reduce postoperative concentrations of heart-type fatty-acid-binding protein, a cardiac biomarker.DesignA double-blind, placebo-controlled, randomized clinical trial.SettingOperating room and pediatric intensive care unit of a university hospital.ParticipantsForty-five infants and young children undergoing ventricular or atrioventricular septal defect correction.InterventionsThe patients received one of the following: 30 mg/kg of methylprednisolone intravenously after anesthesia induction (n = 15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime solution (n = 15), or placebo (n = 15).Measurements And Main ResultsPlasma heart-type fatty-acid-binding protein (hFABP) was measured. Preoperatively, hFABP did not differ among the study groups. Methylprednisolone administered preoperatively and in the cardiopulmonary bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033) 6 hours postoperatively. hFABP significantly correlated with concomitant troponin T after protamine administration (R = 0.811, p < 0.001) and 6 hours postoperatively (R = 0.806, p < 0.001).ConclusionsMethylprednisolone in cardiopulmonary bypass prime solution administered only a few minutes before cardiac ischemia confered cardioprotection of the same magnitude as preoperative methylprednisolone as indicated by hFABP concentrations. Rapid cardioprotective actions of corticosteroids in pediatric heart surgery observed previously experimentally may have occurred.Copyright © 2017. Published by Elsevier Inc.

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