• Gordana Taleska Štupica, Maja Šoštarič, Matej Jenko, and Matej Podbregar.
• University Medical Center Ljubljana, Clinical Department of Anesthesiology and Perioperative Intensive Therapy, Ljubljana, Slovenia; University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia. Electronic address: taleskagordana@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Apr 1; 38 (4): 946956946-956.

ObjectivesCardiopulmonary bypass (CPB) is linked to systemic inflammatory responses and oxidative stress. Paraoxonase 1 (PON1) is an antioxidant enzyme with a cardioprotective role whose activity is decreased in systemic inflammation and in patients with acute myocardial and global ischemia. Glucocorticoids counteract the effect of oxidative stress by upregulating PON1 gene expression. The authors aimed to determine the effect of methylprednisolone on PON1 activity during cardiac surgery on CPB.DesignProspective, randomized, controlled clinical trial.SettingThe University Medical Center Ljubljana, Slovenia.ParticipantsForty adult patients who underwent complex cardiac surgery on CPB between February 2016 and December 2017 were randomized into methylprednisolone and control groups (n = 20 each).InterventionsPatients in the methylprednisolone group received 1 g of methylprednisolone in the CPB priming solution, whereas patients in the control group were not given methylprednisolone during CPB.Measurements And Main ResultsThe effect of methylprednisolone from the CPB priming solution was compared with standard care during CPB on PON1 activity until postoperative day 5. Correlations of PON1 activity with lipid status, mediators of inflammation, and hemodynamics were analyzed also. No significant differences were found between study groups for PON1 activity, high-density lipoprotein, and low-density lipoprotein in any of the measurement intervals (p > 0.016). The methylprednisolone group had significantly lower tumor necrosis factor alpha (p < 0.001) and interleukin-6 (p < 0.001), as well as C-reactive protein and procalcitonin (p < 0.016) after surgery. No significant difference was found between groups for hemodynamic parameters. A positive correlation existed between PON1 and lipid status, whereas a negative correlation was found between PON1 activity and tumor necrosis factor alpha, interleukin-6, and CPB duration.ConclusionsMethylprednisolone does not influence PON1 activity during cardiac surgery on CPB.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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