Glucocorticoids can play a pivotal role in modulating different immune responses. The role of glucocorticoids in cardiac surgery is still controversial as many surgeons are concerned about the potential side effects.
In this review, we looked at the role of glucocorticoid administration in modulating postoperative inflammatory responses, atrial fibrillation (AF) and intimal hyperplasia and whether glucocorticoid use is associated with a significant increase in undesirable postoperative complication.
NewtonR. Molecular mechanisms of glucocorticoid action: what is important?Thorax2000; 55: 603–613.
2.
ClarkAR. Anti-inflammatory functions of glucocorticoid-induced genes. Molecular and Cellular Endocrinology2007; 275: 79–97.
3.
ClarkARMartinsJRSTchenCR. Role of dual specificity phosphatases in biological responses to glucocorticoids. J Biol Chem2008; 283: 25765–25769.
4.
AbrahamSMLawrenceTKleimanA. Antiinflammatory effects of dexamethasone are partly dependent on induction of dual specificity phosphatase 1. J Exp Med2006; 203: 1883–1889.
5.
WhitworthJA. Studies on the mechanisms of glucocorticoid hypertension in humans. Blood Press1994; 3: 24–32.
6.
WhitworthJAMangosGJKellyJJ. Cushing, cortisol, and cardiovascular disease. Hypertension2000; 36: 912–916.
7.
HadokePWFMacdonaldLLogieJJSmallGRDoverARWalkerBR. Intra-vascular glucocorticoid metabolism as a modulator of vascular structure and function. Cell Mol Life Sci2006; 63: 565–578.
8.
RinderC. Cellular inflammatory response and clinical outcome in cardiac surgery. Current Opinion in Anesthesiology2006; 19: 65–68.
9.
KirklinJKGiffinDC. Early complications following cardiac surgery. Cardiovasc Clin1987; 17: 321–343.
10.
WestabyS. Complement and the damaging effects of cardiopulmonary bypass. Thorax1983; 38: 321–325.
11.
AugoustidesJGT. The inflammatory response to cardiac surgery with cardiopulmonary bypass: should steroid prophylaxis be routine?J Cardiothorac Vasc Anesth2012; 26: 952–958.
12.
SablotzkiAMonhlingJDehneMGZickmannBSilberREFriedrichI. Treatment of sepsis in cardiac surgery: role of immunoglobulins. Perfusion2001; 16: 113–120.
13.
NgCSWanS. Limiting inflammatory response to cardiopulmonary bypass: pharmaceutical strategies. Current Opinion in Pharmacology2012; 12: 155–159.
14.
CremerJMartinMRedlH. Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg1996; 61: 1714–1720.
15.
RoystonD. The inflammatory response and extracorporeal circulation. J Cardiothorac Vasc Anesth1997; 11: 341–354.
16.
LevyJHTanakaKA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg2003; 75: S715–S720.
17.
MillerBELevyJH. The inflammatory response to cardiopulmonary bypass. J Cardiothorac Vasc Anesth1997; 11: 355–366.
18.
MitchellJDGrocottHPPhillips-ButeBMathewJPNewmanMFBar-YosefS. Cytokine secretion after cardiac surgery and its relationship to postoperative fever. Cytokine2007; 38: 37–42.
19.
SharmaMGangulyNKChaturvediGThingnamSKSMajumdarSSuriRK. Release of pro-inflammatory mediators during myocardial ischemia/reperfusion in coronary artery bypass graft surgery. Molecular and Cellular Biochemistry2003; 247: 23–30.
20.
SteinbergJBKapelanskiDPOlsenJDWeilerJM. Cytokine and complement levels in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg1993; 106: 1008–1016.
RothenburgerMSoeparwataRDengMC. Prediction of clinical outcome after cardiac surgery: the role of cytokines, endotoxin, and anti-endotoxin core antibodies. Shock2001; 16Suppl 1: 44–50.
23.
NebelsiekTBeirasFKilgerEMohnlePWeisF. Routine use of corticosteroids to prevent inflammation response in cardiac surgery. Recent Pat Cardiovasc Drug Discov2012; 7: 170–174.
24.
DielemanJM. Corticosteroids for the inflammatory response to cardiopulmonary bypass: an update. Curr Pharm Des2012; [Epub ahead of print].
25.
El AzabSRRosseelPMJde LangeJJ. Dexamethasone decreases the pro- to anti-inflammatory cytokine ratio during cardiac surgery. Br J Anaesth2002; 88: 496–501.
26.
JansenNJvan OeverenWvan den BroekL. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac Cardiovasc Surg1991; 102: 515–525.
27.
BronickiRABackerCLBadenHPMavroudisCCrawford GreenTP. Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children. Ann Thorac Surg2000; 69: 1490–1495.
28.
YaredJPStarrNJTorresFK. Effects of single dose, postinduction dexamethasone on recovery after cardiac surgery. Ann Thorac Surg2000; 69: 1420–1424.
29.
YaredJPStarrNJHoffmann-HoggL. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg1998; 87: 795–799.
30.
MurphyGSSherwaniSSSzokolJW. Small-dose dexamethasone improves quality of recovery scores after elective cardiac surgery: a randomized, double-blind, placebo-controlled study. J Cardiothorac Vasc Anesth2011; 25: 950–960.
31.
SobieskiMA2ndGrahamJDPappasPSTatoolesAJSlaughterMS. Reducing the effects of the systemic inflammatory response to cardiopulmonary bypass: can single dose steroids blunt systemic inflammatory response syndrome?ASAIO J2008; 54: 203–206.
32.
MorariuAMLoefBGAartsLPHJ. Dexamethasone: benefit and prejudice for patients undergoing on-pump coronary artery bypass grafting: a study on myocardial, pulmonary, renal, intestinal, and hepatic injury. Chest2005; 128: 2677–2687.
33.
CappabiancaGRotunnoCde Luca Tupputi SchinosaLRanieriVMPaparellaD. Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials. J Cardiothorac Vasc Anesth2011; 25: 156–165.
34.
HoKMTanJA. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery. Circulation2009; 119: 1853–1866.
35.
DielemanJMNierichAPRosseelPM. Dexamethasone for Cardiac Surgery (DECS) Study Group. Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial. JAMA2012; 308: 1761–1767.
36.
ShinguYKubotaSWakasaSOokaTTachibanaTMatsuiY. Postoperative atrial fibrillation: mechanism, prevention, and future perspective. Surgery Today2012; 42: 819–824.
37.
MaysonSEGreensponAJAdamsS. The changing face of postoperative atrial fibrillation prevention: a review of current medical therapy. Cardiology in Review2007; 15: 231–241.
38.
MitchellLB. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention and treatment of atrial fibrillation following cardiac surgery. Can J Cardiol2011; 27: 91–97.
39.
MaesenBNijsJMaessenJAllessieMSchottenU. Postoperative atrial fibrillation: a maze of mechanisms. Europace2012; 14: 159–174.
40.
ChungMKMartinDOSprecherD. C-reactive protein elevation in patients with atrial arrhythmias. Circulation2001; 104: 2886–2891.
41.
HalonenJ. Corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial. JAMA2007; 297: 1562–1567.
42.
PrasongsukarnKAbelJGJamiesonWRE. The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial. J Thorac cardiovasc Surg2005; 130:93–98.
43.
YaredJPBakriMHErzurumSC. Effect of dexamethasone on atrial fibrillation after cardiac surgery: prospective, randomized, double-blind, placebo-controlled trial. J Cardiothorac Vasc Anesth2007; 21: 68–75.
44.
BakerWLWhiteCMKlugerJDenowitzAKonecnyCPColemanCI. Effect of perioperative corticosteroid use on the incidence of postcardiothoracic surgery atrial fibrillation and length of stay. Heart rhythm2007; 4: 461–468.
45.
MarikPEFrommR. The efficacy and dosage effect of corticosteroids for the prevention of atrial fibrillation after cardiac surgery: a systematic review. J Critical Care2009; 24: 458–463.
FitzgibbonGMKafkaHPLeachAJKeonWJHooperGDBurtonJR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol1996; 28: 616–626.
BryanAJAngeliniGD. The biology of saphenous vein graft occlusion: etiology and strategies for prevention. Curr Opin Cardiol1994; 9: 641–649.
50.
MitraAKGangaharDMAgrawalDK. Cellular, molecular and immunological mechanisms in the pathophysiology of vein graft intimal hyperplasia. Immunol Cell Biol2006
; 84: 115–124.
DaviesMGHagenPO. Pathophysiology of vein graft failure: a review. Eur J Vasc Endovasc Surg1995; 9: 7–18.
56.
KweiSStavrakisGTakahasM. Early adaptive responses of the vascular wall during venous arterialization in mice. Am J Pathol2004; 164: 81–89.
57.
StarkVKHochJRWarnerTFHullettDA. Monocyte chemotactic protein-1 expression is associated with the development of vein graft intimal hyperplasia. Arterioscler Thromb Vasc Biol1997; 17: 1614–1621.
58.
GeorgeSJLloydCTAngeliniGDNewbyACBakerAH. Inhibition of late vein graft neointima formation in human and porcine models by adenovirus-mediated overexpression of tissue inhibitor of metalloproteinase-3. Circulation2000; 101: 296–304.
59.
YangZKozaiTvandeLooB. HMG-CoA reductase inhibition improves endothelial cell function and inhibits smooth muscle cell proliferation in human saphenous veins. J Am Coll Cardiol2000; 36: 1691–1697.
60.
SaundersPCPintucciGBizekisCS. Vein graft arterialization causes differential activation of mitogen-activated protein kinases. J Thorac Cardiovasc Surg2004; 127: 1276–1284.
61.
GulkarovIBohmannKCinnanteKM. Topical mitogen-activated protein kinases inhibition reduces intimal hyperplasia in arterialized vein grafts. J Surg Res2009; 154: 150–156.
62.
ChungAWWongJLuoHHsiangYNvan BreemenCOkonEB. Arterialization of a vein graft promotes cell cycle progression through Akt and p38 mitogen-activated protein kinase pathways: impact of the preparation procedure. Can J Cardiol2007; 23: 1147–1154.
63.
MiyakeTAokiMShirayaS. Inhibitory effects of NF-κB decoy oligodeoxynucleotides on neointimal hyperplasia in a rabbit vein graft model. J Mol Cell Cardiol2006; 41: 431–440.
ZakkarMLuongLAChaudhuryH. Dexamethasone arterializes venous endothelial cells by inducing mitogen-activated protein kinase phosphatase-1: a novel antiinflammatory treatment for vein grafts. Circulation2011; 123: 524–532.
66.
VersaciFGaspardoneATomaiF. Immunosuppressive therapy for the prevention of restenosis after coronary artery stent implantation (IMPRESS study). J Am Coll Cardiol2002; 40: 1935–1942.
67.
LiuXHuangYHanetC. Study of antirestenosis with the BiodivYsio dexamethasone-eluting stent (STRIDE): a first-in-human multicenter pilot trial. Cathet Cardiovasc Intervent2003; 60: 172–178.
68.
Jimenez-ValeroSSantosBPajinF. Clinical outcomes of dexamethasone-eluting stent implantation in ST-elevation acute myocardial infarction. Cathet Cardiovasc Intervent2007; 70: 492–497.
69.
ReichardtHMTuckermannJPBauerASchützG. Molecular genetic dissection of glucocorticoid receptor function in vivo. Z Rheumatol2000; 59Suppl 2: II/1–5.
