Reduction of Inflammation by High-Dose Methylprednisolone Does not Attenuate Oxidative Stress in Children Undergoing Bidirectional Glenn Procedure With or Without Aortic Arch or Pulmonary Arterial Repair

Keski‐Nisula, Juho; Arvola, Oiva; Jahnukainen, Timo; Andersson, Sture; Pesonen, Eero

doi:10.1053/j.jvca.2019.10.015

Cited by 12 publications

(3 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, only five adult patients with VSD were included; this subgroup was too small to perform a separate statistical analysis. In contrast, in most other studies on oxidative stress in the blood of patients with CHD, indirect nonspecific markers of oxidative stress [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ] were used, e.g., the assessment of the activity of oxidative and antioxidant enzymes (superoxide dismutase (SOD), catalase and glutathione peroxidase), levels of antioxidants (vitamin E, uric acid and selenium), levels of malondialdehyde (MDA) and protein carbonyl (PCO), plasma total oxidant status (TOS), total antioxidant capacity or status (TAC or TAS) and oxidative stress index (OSI) as well as the quantification of DNA damage assessed by alkaline comet assay in circulating lymphocytes and levels of 8-hydroxy-2′-deoxyguanosine.…”

Section: Discussionmentioning

confidence: 88%

Circulating Reactive Oxygen Species in Adults with Congenital Heart Disease

et al. 2022

View full text Add to dashboard Cite

Oxidative stress is an important pathophysiological mechanism in the development of numerous cardiovascular disorders, but few studies have examined the levels of oxidative stress in adults with congenital heart disease (CHD). The objective of this study was to investigate oxidative stress levels in adults with CHD and the association with inflammation, exercise capacity and endothelial function. To this end, 36 adults with different types of CHD and 36 age- and gender-matched healthy controls were enrolled. Blood cell counts, hs-CRP, NT-proBNP, fasting glucose, cholesterol levels, iron saturation and folic acid concentrations were determined in venous blood samples. Levels of superoxide anion radical in whole blood were determined using electron paramagnetic resonance spectroscopy in combination with the spin probe CMH. Physical activity was assessed with the IPAQ-SF questionnaire. Vascular function assessment (EndoPAT) and cardiopulmonary exercise testing were performed in the patient group. Superoxide anion radical levels were not statistically significantly different between adults with CHD and the matched controls. Moreover, oxidative stress did not correlate with inflammation, or with endothelial function or cardiorespiratory fitness in CHD; however, a significant negative correlation with iron saturation was observed. Overall, whole blood superoxide anion radical levels in adults with CHD were not elevated, but iron levels seem to play a more important role in oxidative stress mechanisms in CHD than in healthy controls. More research will be needed to improve our understanding of the underlying pathophysiology of CHD.

show abstract

Section: Discussionmentioning

confidence: 88%

Circulating Reactive Oxygen Species in Adults with Congenital Heart Disease

et al. 2022

View full text Add to dashboard Cite

show abstract

“…During S2P, methylprednisolone (30 mg/kg) reduced the inflammatory biomarkers IL-6 and IL-8 and increased the anti-inflammatory cytokine IL-10 from cardiopulmonary bypass to 6 h after surgery, without a significant difference in clinical outcome. 25 The impact of perioperative strategy on hypoplastic left heart syndrome patients (Supplementary Table S7) Regional cerebral perfusion during Norwood procedure did not differ in 1-year survival compared to that of deep hypothermic circulatory arrest. 4 Additionally, remote ischaemic preconditioning, nitric oxide usage in the oxygenator during cardiopulmonary bypass, and a single dose of caudal morphine did not improve clinical outcomes.…”

Section: Comparison Of Outcomes Between Right Ventricle-topulmonary A...mentioning

confidence: 99%

Treatment of hypoplastic left heart syndrome: a systematic review and meta-analysis of randomised controlled trials

Kim,

Woo,

Saxena

et al. 2023

Cardiol Young

View full text Add to dashboard Cite

Background: This meta-analysis aimed to consolidate existing data from randomised controlled trials on hypoplastic left heart syndrome. Methods: Hypoplastic left heart syndrome specific randomised controlled trials published between January 2005 and September 2021 in MEDLINE, EMBASE, and Cochrane databases were included. Regardless of clinical outcomes, we included all randomised controlled trials about hypoplastic left heart syndrome and categorised them according to their results. Two reviewers independently assessed for eligibility, relevance, and data extraction. The primary outcome was mortality after Norwood surgery. Study quality and heterogeneity were assessed. A random-effects model was used for analysis. Results: Of the 33 included randomised controlled trials, 21 compared right ventricle-to-pulmonary artery shunt and modified Blalock–Taussig-Thomas shunt during the Norwood procedure, and 12 regarded medication, surgical strategy, cardiopulmonary bypass tactics, and ICU management. Survival rates up to 1 year were superior in the right ventricle-to-pulmonary artery shunt group; this difference began to disappear at 3 years and remained unchanged until 6 years. The right ventricle-to-pulmonary artery shunt group had a significantly higher reintervention rate from the interstage to the 6-year follow-up period. Right ventricular function was better in the modified Blalock–Taussig-Thomas shunt group 1–3 years after the Norwood procedure, but its superiority diminished in the 6-year follow-up. Randomised controlled trials regarding medical treatment, surgical strategy during cardiopulmonary bypass, and ICU management yielded insignificant results. Conclusions: Although right ventricle-to-pulmonary artery shunt appeared to be superior in the early period, the two shunts applied during the Norwood procedure demonstrated comparable long-term prognosis despite high reintervention rates in right ventricle-to-pulmonary artery shunt due to pulmonary artery stenosis. For medical/perioperative management of hypoplastic left heart syndrome, further randomised controlled trials are needed to deliver specific evidence-based recommendations.

show abstract

“…In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Keski-Nisula et al report findings from a single-center, randomized controlled trial evaluating the effect of methylprednisolone administration on oxidative stress in infants with single ventricle physiology undergoing bidirectional Glenn surgeries. 6 Recognizing that inflammation produces free-oxygen radicals and that patients with cyanotic heart lesions are particularly prone to increased free-radical stress during cardiac surgery, the authors hypothesized that administration of high-dose methylprednisolone (30 mg/kg) would attenuate both inflammation and oxidative stress. In a small number of evaluated patients (n = 29), although steroids resulted in reduced inflammation, they did not lead to decreased free-radical stress.…”

mentioning

confidence: 99%