Detection of TNF-alpha in Serum as the Effect of Corticosteroid to the Myocardial Protection in Cardiopulmonary Bypass

Choi, Young Ho; Kim, Oug Jin; Kim, Tae Sik; Jo, Won Min; Kim, Hak Jae

Abstract

Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass (CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group (n=10), corticosteroid (dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group (n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-alpha bioassays. We have checked EKG, cardiac enzymes (CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day (CPK; 1122+/-465 vs 567+/-271, 864+/-42 vs 325+/-87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day (106.4+/-115.1 vs 29.5+/-22.4) (P=0.02). Arterial tumor necrosis factor-alpha rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping (ACC-5min) in steroid group (11.9+/-4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass (CPB-5min) in control group (22.3+/-6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.