Corticosteroid Prophylaxis on the Cardiopulmonary Bypass-Induced Systemic Inflammatory Response

Study Overview
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Brief Summary
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To observe the effect of glucocorticoid on the dynamic changes of monocyte subsets in the peripheral blood of valve disease patients undergoing cardiopulmonary bypass perioperatively.

Detailed Description
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Systemic inflammatory response syndrome (SIRS) is a common major complication of cardiopulmonary bypass. Emergency Hematopoiesis is the pathological process induced by the inflammation. The investigators previously confirmed that emergency hematopoiesis induced by cardiopulmonary bypass led to dynamic changes of quantities of monocyte subsets, there is a significant increase in the number of two monocyte subsets: 1) CD14highCD16+ monocyte with strong immunomodulatory activity; 2) CD14lowCD16- monocyte with potential ability of proliferation and differentiation. Therefore, a new hypothesis risen: the change of the function and the number of monocyte subsets induced by emergency hematopoiesis play an important role for SIRS occurrence after cardiopulmonary bypass, correcting emergency hematopoiesis is a new breakthrough in the prevention and treatment of SIRS. To identify the mechanism of function changed in different monocyte subsets during the pathogenesis of SIRS, the research intended to target perioperative-period patients with heart valve replacement, monitor dynamically the number and phenotype of peripheral blood monocyte subsets by flow cytometry; sort out of different monocyte subsets for cell culture in vitro, observe the ability of proliferation and differentiation and effects between monocyte subsets and T lymphocyte; investigate the mechanism of immune function changes with antibody-blocking and compartment culture in patients; observe the impact of glucocorticoid treatment on the emergency hematopoiesis, offer new objects for evaluation of immune status in patients and provide new evidence for anti-inflammatory therapy . Patients should be follow the protocol of cardiopulmonary bypass according to normal hospital routine practice. A total of 30 patients will be enrolled in this clinical trial.

Official Title
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The Perioperative Effect of Corticosteroid Prophylaxis on the Cardiopulmonary Bypass-Induced Systemic Inflammatory Response

Conditions
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Heart Valve Diseases, Systemic Inflammatory Response Syndrome

Intervention / Treatment
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* Drug: Corticosteroid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Valve replacement under cardiopulmonary bypass Exclusion Criteria: Cardiopulmonary bypass time over 120 minutes Hyperlipidemia Diabetes mellitus Autoimmune diseases

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Corticosteroid<br>Methylprednisolone will be given during cardiopulmonary bypass. | Drug: Corticosteroid<br>* 500mg Methylprednisolone will be in the priming of cardiopulmonary bypass.<br>* Other names: Solu-Medrol;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| recovery of monocyte subsets | Changes in monocyte subsets in cardiopulmonary bypass patients were found.After 1w-2w postoperatively, it would recover to the preoperative level. | baseline, day1, 3, 5, 7 postoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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monocyte, cardiopulmonary bypass, cardiac surgery