Methylprednisolone and full-dose aprotinin reduce reperfusion injury after cardiopulmonary bypass

Objective: To compare the effects of low- and full-dose aprotinin to methylprednisolone (MPS) in reducing cardiopulmonary bypass (CPB)-induced interleukin-6 (IL-6) release. Design: Prospective, randomized, blinded study. Setting: Cytokine Laboratory, pharmacology department, in a university teaching hospital. Participants: Forty adult male human patients scheduled for myocardial revascularization were divided into four groups (n = 10): (1) control; (2) MPS, 1 g IV before CPB; (3) aprotinin-low-dose protocol; and (4) aprotinin-full-dose protocol. Measurements and Main Results: Plasma levels of IL-6 were measured at baseline and 1 and 24 hours after CPB by enzyme-linked immunosorbent assay technique. Group 1 demonstrated a significant (p < 0.05) increase in IL-6 at 1 and 24 hours post-CPB. Groups 2 and 4 demonstrated significant (p < 0.05) reduction of IL-6 at 1 (group 2 only) and 24 (groups 2 and 4) hours post-CPB when compared with group 1 at the same time periods. Conclusions: These results demonstrate that MPS, 1 g before CPB, and full- dose aprotinin, but not half-dose aprotinin, achieve significant reduction in IL-6 release after CPB. These results further suggest that MPS and full-dose aprotinin may reduce reperfusion injury after CPB.