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CLINICAL STUDY: PEDIATRIC CARDIOLOGY

The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass

Antonio R. Mott, MD^*, Charles D. Fraser, Jr, MD, FACC, Anita V. Kusnoor^*, N. Martin Giesecke, MD, George J. Reul, Jr, MD, FACC, Kathy L. Drescher, RN, Carmen H. Watrin, RN, E. O.’Brian Smith, PhD^* and Timothy F. Feltes, MD, FACC^*

^* Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston, Texas, USA

Manuscript received August 29, 2000; revised manuscript received January 19, 2001, accepted February 1, 2001.

Reprint requests and correspondence: Dr. Antonio R. Mott, the Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin, MC# 2-2280, Houston, Texas 77030
AMott{at}bcm.tmc.edu

OBJECTIVE

The aim of this study was to determine the effect of prophylactic immune suppression on the incidence and severity of postpericardiotomy syndrome (PPS) in children after cardiac surgery with cardiopulmonary bypass (CPB).

BACKGROUND

Prophylactic suppression of the inflammatory response has an unknown effect on the incidence and severity of PPS in children undergoing surgery with CPB.

METHODS

This randomized double-blind placebo controlled trial included two study groups. Group A received pre-CPB intravenous methylprednisolone (1 mg/kg) plus four additional intravenous doses over 24 h, and Group B received intravenous saline placebo at identical intervals. Data included patient demographics, cardiac diagnosis/operation, CPB time, incidence and severity of PPS. Noncomplicated PPS—temperature >100.5°F, pericardial friction rub, patient irritability, small pericardial ± pleural effusion. Complicated PPS—noncomplicated PPS plus hospital readmission ± pericardiocentesis or thoracentesis.

RESULTS

We randomized 266 children: 20 exclusions (6 perioperative deaths, 14 reasons unrelated to treatment) leaving Group A (n = 126) and Group B (n = 120). There were no significant group differences in gender, cardiac diagnosis or CPB time. Group mean age differed (p = 0.05) and was treated as a covariate with no substantive outcome effect. In total, 39/246 children (16%) developed PPS (noncomplicated: n = 30, complicated: n = 9). There was no inter-group difference in overall PPS incidence (p = 0.73). However, Group A had a marginally significant increase in complicated PPS (p = 0.05).

CONCLUSIONS

Intravenous methylprednisolone at a standard anti-inflammatory dose administered pre-CPB and early post-CPB neither prevents nor attenuates PPS in children. Short-term pre-CPB and post-CPB methylprednisolone treatment may complicate PPS.

Abbreviations and Acronyms   CPB = cardiopulmonary bypass   PPS = postpericardiotomy syndrome

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