Clinical InvestigationSurgeryDexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy
Section snippets
Study design and population
The DECS study was a multicenter, randomized, double-blind, placebo-controlled trial comparing a single intraoperative dose of 1 mg/kg dexamethasone with placebo in 4,494 patients undergoing cardiac surgery, between April 13, 2006, and November 23, 2011, in 8 centers in The Netherlands (trial registration: ClinicalTrials.gov, number NCT00293592). Inclusion criteria were age >18 years and elective or urgent cardiac surgery requiring CPB. Exclusion criteria were emergency and off-pump procedures.
Baseline characteristics
Of the 852 patients undergoing valvular surgery, 30 (3.5%) were excluded because of missing echocardiograms (n = 20) or missing clinical data (n = 10). The flowchart of patients in the present study is depicted in Figure. A total of 401 patients were randomized to receive placebo treatment, and 421 patients received dexamethasone. The baseline characteristics are listed in Table I. The study groups were similar with respect to all demographic, clinical, and surgical characteristics, except for
Discussion
The present study is the largest trial investigating the potential beneficial effect of corticosteroids on the incidence of PPS after cardiac surgery. We found no protective effect of a single high intraoperative dose of dexamethasone on the occurrence of PPS or complicated PPS in a cohort of adult patients undergoing valvular surgery.
The etiology of PPS is not exactly known, but multiple factors related to inflammation are involved. First, it has been hypothesized that surgical trauma may
Conclusion
Prophylactic dexamethasone treatment was not able to reduce the occurrence of PPS or complicated PPS. A useful preventive strategy for PPS as a common complication after cardiac surgery remains to be defined, as patients who develop PPS are at risk for complications.
Disclosures
Conflict of interests
All authors report no conflicts of interests.
References (21)
- et al.
Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies
Chest
(1997) - et al.
Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome
Am J Cardiol
(2011) - et al.
Postcardiac injury syndrome. An immunologic pleural fluid analysis
Chest
(1996) - et al.
Elevated antinuclear antibody titers and the postpericardiotomy syndrome
J Pediatr
(1990) - et al.
The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass
J Am Coll Cardiol
(2001) - et al.
The effective treatment of postpericardiotomy syndrome after cardiac operations. A randomized placebo-controlled trial
J Thorac Cardiovasc Surg
(1990) - et al.
The epidemiology of the postpericardiotomy syndrome: a common complication of cardiac surgery
Am Heart J
(1988) - et al.
Prophylactic corticosteroids for cardiopulmonary bypass in adults
Cochrane Database Syst Rev
(2011) - et al.
Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial
JAMA
(2012) - et al.
Postpericardiotomy syndrome: a proposal for diagnostic criteria
J Cardiovasc Med (Hagerstown)
(2013)
Cited by (37)
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
2021, Structural HeartCommentary: Postpericardial syndrome after cardiac surgery: Is it really benign?
2020, Journal of Thoracic and Cardiovascular SurgeryRisk factors and prognosis of postpericardiotomy syndrome in patients undergoing valve surgery
2017, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :However, after multivariable analysis there was no significant association between chronic corticosteroid use and PPS anymore, questioning the potential efficacy of corticosteroid treatment for the prevention of PPS. Earlier trials investigating corticosteroid treatment for the prevention of PPS also do not show convincing evidence in favor of corticosteroids.6,18,19 In our study, treatment for pulmonary disease was defined as pulmonary disease requiring daily inhaled maintenance treatment with bronchodilators and/or corticosteroids.
The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016
2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The incidence of postoperative cognitive dysfunction also was not a function of steroid exposure both at 1 month (RR 1.87; 95% CI 0.90-3.88; p = 0.09) and at 1 year (RR 1.98; 95% CI 0.61-6.40; p = 0.24) after surgery.110 In a similar fashion, further cohort analysis examined whether high-dose dexamethasone influenced the risks of redo thoracotomy and postpericardiotomy syndrome after cardiac surgery with CPB.111,112 Steroid exposure in this setting appeared to increase the risk of redo thoracotomy for bleeding (9.7% v 7.3%; RR 1.32; 95% CI 1.09-1.61; p = 0.005).111
Management of pericardial effusion: systematic review of literature
2018, Revista Colombiana de CardiologiaProphylactic corticosteroids for cardiopulmonary bypass in adult cardiac surgery
2024, Cochrane Database of Systematic Reviews
Funding: The DECS trial was supported by grants 80-82310-98-08607 from the Netherlands Organization for Health Research and Development (ZonMw) and 2007B125 from the Dutch Heart Foundation. No extramural funding was used to support this substudy.
- d
J.J.H. Bunge and D. van Osch contributed equally to this work.