Reexploring the STRESS Trial: Subgroup Post-op Outcomes Following Methylprednisolone for Infant Heart Surgery | Subgroup Analysis | 24 congenital heart centers | 2010-2020 | infants <1yr undergoing heart surgery with cardiopulmonary bypass | double-blind placebo-controlled randomized controlled trial | Does giving methylprednisolone during infant heart surgery improve post-op outcomes? | Potential benefits: | Fewer reinterventions after lower-risk operations | Fewer reoperations for bleeding in low-risk surgeries, full-term infants, & infants without syndromes | No reduction in: | mortality | heart transplant | mechanical circulatory support | hospital length of stay | Methylprednisolone was NOT associated w/ significant harm. | Conclusion: Routine methylprednisolone did not improve major post-op outcomes for all infants, but certain lower-risk groups may experience fewer complications and reinterventions. | https://pubmed.ncbi.nlm.nih.gov/40314766/ | Sunthankar SD et. al. | Division of Pediatric Cardiology and Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, USA | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's
Reexploring the STRESS Trial: Subgroup Postoperative Outcomes Following Methylprednisolone for Infant Heart Surgery
Infographic · Jul 2026 · 1 min read
In brief
In brief
Subgroup analysis of the STRESS trial found methylprednisolone (30 mg/kg) in bypass priming fluid reduced reinterventions and bleeding complications in lower-risk infant cardiac surgery cases, particularly among term infants without chromosomal abnormalities. While not reducing mortality or mechanical support needs, the steroid showed potential benefit in select populations without significant harm across 24 congenital heart centers.
- Methylprednisolone (30 mg/kg in CPB prime) did not reduce mortality, transplant, or mechanical circulatory support in any infant subgroup.
- Methylprednisolone reduced reinterventions (cath/surgery) by 50% in STAT 1-3 cases and cut reoperation for bleeding by 72% in term infants.
- Infants without chromosomal/syndromic diagnoses showed favorable composite outcomes with methylprednisolone (win ratio 1.28).
- No difference in hospital length of stay between methylprednisolone and placebo across all subgroups analyzed.
- Subgroup analyses suggest methylprednisolone is safe and may benefit select populations, though study was underpowered for definitive conclusions.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and coral color scheme with illustrated icons including a magnifying glass over charts, a hospital building, and three surgeons performing an operation. Key findings are presented in colored boxes with bullet points, creating a visual hierarchy that guides the reader from study design through results to conclusions.