Improved myocardial protection and cardiopulmonary bypass (CPB) have limited, but not abolished, intraoperative myocardial damage due to surgical reperfusion injury after release of the aortic crossclamp. In this double-blind, randomized study, we evaluated whether short-term leukocyte filtration during reperfusion may further reduce myocardial damage. Thirty-eight patients with coronary artery disease were randomly assigned to CPB with (group I; n = 19) or without leukocyte filtration (group II; n = 19). There was no difference in bypass time or crossclamp time between the groups. No patient in group I required catecholamines, whereas three patients in group II were supported with adrenaline or dobutamine on the first and second postoperative day. In addition, troponin T plasma levels were lower in group I (p < 0.05), whereas other markers for tissue injury (CK, CK-MB, LDH, S- GOT and S100B) did not differ. In conclusion, leukocyte filtration during reperfusion may further improve CPB by reducing myocardial damage.
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References
1.
Kirklin JK, Westaby S., Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico ADComplement and the damaging effects of cardiopulmonary bypassJ Thorac Cardiovasc Surg1983; 86: 845-57.
Taylor KM, Central nervous system effects of cardiopulmonary bypassAnn Thorac Surg1998; 66 : 20-24.
4.
Moen O., Hagasen K., Fosse E. et al.Attenuation of changes in leukocyte surface markers and complement activation with heparin-coated cardiopulmonary bypassAnn Thorac Surg1997, 63 : 105-11.
5.
Fosse E., Thelin S., Svennevig JL et al.Duraflo-IIcoating of cardiopulmonary bypass circuits reduces complement activation, but does not affect the release of granulocyte enzymes: a European multicenter studyEur J Cardiothorac Surg1997; 11: 320-27.
6.
Ovrum E., Fosse E., Mollnes TE et al.Complete heparine-coated cardiopulmonary bypass and low heparine dose reduce complement and granulocyte activationEur J Cardiothorac Surg1996; 10: 54-60.
7.
Lane TA, Anderson KC, Goodnough LT et al.Leukocyte reduction in blood component therapyAnn Intern Med1992; 117: 151-62.
8.
Eisenfeld L. , Silver H., McLaughlin J. et al.Prevention of transfusion-associated cytomegalovirus infection in neonatal patients by the removal of white cells from bloodTransfusion1992; 32: 205-209.
9.
Breda MA, Drinkwater DC, Laks H. et al.Prevention of reperfusion injury in the neonatal heart with leukocyte depleted bloodJ Thorac Cardiovasc Surg1989; 97: 654-65.
10.
Bando K., Pillai R., Cameron DE et al.Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypassJ Thorac Cardiovasc Surg1990; 99: 873-77.
Johnson D., Thompson D., Mycyk T., Burbridge B., Mayers I.Depletion of neutrophils by filter during aortocoronary bypass surgery transiently improves postoperative cardiorespiratory statusChest1995: 107 : 1253-59.
15.
Mihaljevic T., Tonz M., von Segesser LK et al.The influence of leukocyte filtration during cardiopulmonary bypass on postoperative lung function: a clinical studyJ Thorac Cardiovasc Surg1995; 109: 1138-45.
16.
Gu YJ, de Vries AJ, Boonstra PW, van Oeveren W.Clinical performance of a high efficacy rapid flow leucocyte removal filter for leucocyte depletion of heparinized cardiopulmonary bypass perfusatePerfusion1995; 10: 425-30.
17.
Gu YJ, Obster R., Haan J., Gallandat Huet RC, Eijgelaar A., van Oeveren W.Biocompatibility of leukocyte removal filters during leukocyte filtration of cardiopulmonary bypass perfusateArtif Organs1993; 17: 660-65.
18.
Mair J.Cardiac troponin I and troponin T: are enzymes still relevant as cardiac markers?Clin Chim Acta1997 ; 257: 99-115.
19.
Kraemer R., Mullane KMNeutrophils delay functional recovery of the post-hypoxic heart of the rabbitJ Pharmacol Exp Ther1989 ; 251: 620-26.
20.
Videm V., Fosse E., Mollnes TE, Garred P., Svennevig JLTime for new concepts about measurement of complement activation by cardiopulmonary bypassAnn Thorac Surg1992; 54: 725-31.
21.
Engler R.Consequences of activation and adenosine-mediated inhibition of granulocytes during myocardial ischemiaFed Proc1987, 46: 2407-12.
22.
Gu YJ, de Vries AJ, Boonstra PW, van Oeveren W.Leukocyte depletion results in improved lung function and reduced inflammatory response after cardiac surgeryJ Thorac Cardiovasc Surg1996; 112: 494-500.
Moat NE, Shore D., Fevans TWOrgan dysfunction and cardiopulmonary bypass: the role of complement and complement regulatory proteinsEur J Cardiothorac Surg1993; 7: 563-73.
25.
Weisman HF, Bartow T., Leppo MK et al.Soluble human receptor type 1: in vivo inhibitor of complement suppressing post-ischemic myocardial inflammation and necrosisScience1990; 249: 146-51.
