Leucocyte-depleted cardioplegia does not reduce reperfusion injury in hypothermic coronary artery bypass surgery

Abstract

This study investigated the effects of leucocyte-depleted cardioplegia on postreperfusion oxidative stress and myocardial injury in elective hypothermic coronary artery bypass surgery. Forty patients were randomized to receive either cardioplegia with leucocytes depleted by an in-line Pall BC1B filter, or blood cardioplegia without leucocyte depletion. Transmyocardial oxidative stress was assessed by oxidized glutathione measurements in samples taken simultaneously from the coronary sinus and aortic root, and myocardial injury by postoperative CKMB and troponin-T measurements. The BC1B filters reduced numbers of cardioplegia leucocytes by a mean of 90.7%. Both patient groups demonstrated significant increases (p < 0.001) in transcardiac oxidized glutathione gradients after crossclamp release. No significant differences were found between the groups for postreperfusion oxidized glutathione gradients, postoperative levels of CKMB or troponin-T, or in the frequency of perioperative and postoperative complications. These results suggest that leucocyte-depleted cardioplegia does not significantly improve myocardial protection in patients undergoing elective coronary artery bypass surgery.

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References

Rashid A , Fabri BM , Jackson M et al. A prospective randomised study of continuous warm versus intermittent cold blood cardioplegia for coronary artery surgery: preliminary report . Eur J Cardiothorac Surg 1994; 8: 265-269 .

Grech ED , Baines M , Steyn R et al. Evidence that continuous normothermic blood cardioplegia offers better myocardial protection than intermittent hypothermic cardioplegia . Br Heart Jnl 1995; 74: 517-521 .

Boyle EMJ , Pohlman TH , Cornejo CJ , Verrier ED. Endothelial cell injury in cardiovascular surgery: ischemia-reperfusion . Ann Thorac Surg 1996; 62: 1868-1875 .

Kilgore KS , Friedrichs GS , Homeister JW , Lucchesi BR. The complement system in myocardial ischaemia/reperfusion injury . Cardiovasc Res 1994; 28: 437-444 .

Hansen PR. Role of neutrophils in myocardial ischemia and reperfusion . Circulation 1995; 91: 1872-1885 .

Frangogiannis NG , Youker KA , Entman ML. The role of the neutrophil in myocardial ischaemia and reperfusion . EXS 1996; 76: 263-284

Lefer DJ , Shandelya SM , Serrano CVJ , Becker LC , Kuppusamy P , Zweier JL. Cardioprotective actions of a monoclonal antibody against CD-18 in myocardial ischemia-reperfusion injury . Circulation 1993; 88: 1779-1787 .

Palanzo D , Manley NJ , Montesano RM , Yeisley GL , Gordon D. Clinical evaluation of the leukoguard (LG6) arterial line filter for routine open-heart surgery . Perfusion 1993; 8: 489-496 .

Johnson D , Thomson D , Mycyk T , Burbridge B , Mayers I. Depletion of neutrophils by filter during aortocoronary bypass surgery transiently improves postoperative cardiorespiratory status . Chest 1995; 107: 1253-1259 .

10.

Hachida M , Hanayama N , Okamura T et al. The role of leucocyte depletion in reducing injury to myocardium and lung during cardiopulmonary bypass . ASAIO 1995; 41: M291-M294 .

11.

Ogiwara M , Kyo S , Hatanaka M et al. A clinical study using the leucocyte depleting arterial line filter (LG6) for cardiopulmonary bypass . Jpn J Art Org 1996; 25: 321-324 .

12.

Tillmanns H , Leinberger H , Neumann FJ , Steinhausen M , Parekh N , Zimmerman R. Early microcirculatory changes during brief ischaemia - primary events in ischaemic myocardial injury . Circulation 1984; 70(suppl II): 88-88 .

13.

Weiss SJ. Tissue destruction by neutrophils . N Engl J Med 1989; 320: 365-376 .

14.

Pearl JM , Drinkwater DC , Laks H , Capouya ER , Gates RN. Leukocyte-depleted reperfusion of transplanted human hearts: a randomised, double-blind clinical trial . J Heart Lung Transplant 1992; 11: 1082-1092 .

15.

Sawa Y , Matsuda H , Shimazaki Y et al. Evaluation of leukocyte-depleted terminal blood cardioplegic solution in patients undergoing elective and emergency coronary artery bypass grafting . J Thorac Cardiovasc Surg 1994; 108: 1125-1131 .

16.

Pala MG , Paolini G , Paroni R et al. Myocardial protection with and without leucocyte depletion: A comparative study on the oxidative stress . Eighth Annual Meeting of the European Association for Cardio-Thoracic Surgery, The Hague, The Netherlands, 25-28 September 1994.

17.

Palatianos G , Balentine G. Leucocyte-filtered blood cardioplegia and controlled reperfusion . Third International Congress of the Society for Cardiovascular Surgery, Berlin, 1994.

18.

Ichihara T , Yasuura K , Maseki T et al. The effects of using a leukocyte removal filter during cold blood cardioplegia . Surg Today 1994; 24: 966-972 .

19.

Suzuki I , Ogoshi N , Chiba M , Komatsu T , Moizumi Y. Clinical evaluation of a leucocyte-depleting blood cardioplegia filter (BC1B) for elective open-heart surgery . Perfusion 1998; 13: 205-210 .

20.

Abdalla EK , Caty MG , Guice KS , Hinshaw DB , Oldham KT. Arterial levels of oxidised glutathione (GSSG) reflect oxidant stress in vivo . J Surg Res 1990; 48: 291-296 .

21.

Christopher MF , Gordon AT , Gregory JW et al. Multidose blood versus crystalloid cardioplegia . J Thorac Cardiovasc Surg 1984; 87: 585-595 .

22.

Stephen EF , George TC , Richard DW et al. A clinical trial of blood and crystalloid cardioplegia . J Thorac Cardiovasc Surg 1984; 88: 726-741 .

23.

Heggie AJ , Corder JS , Crichton PR , Hesford JW , Bingham H , Jeffries S. Clinical evaluation of the new Pall leucocyte-depleting blood cardioplegia filter (BC1) . Perfusion 1998; 13, 17-25 .

24.

Sies H , Akerboom TP. Glutathione disulphide (GSSG) efflux from cells and tissues . Meth Enzymol 1984; 105: 445-451 .

25.

Ferrari R , Ceconi C , Curello S , Cargnoni A , De Giuli F , Visioli O. Occurrence of oxidative stress during myocardial reperfusion . Mol Cell Biochem 1992; 111: 61-69 .

26.

Chello M , Mastroroberto P , Romano R , Ascione R , Pantaleo D , De Amicis V. Complement and neutrophil activation during cardiopulmonary bypass: a randomised comparison of hypothermic and normothermic circulation . Eur J Cardiothorac Surg 1997; 11: 162-168 .

27.

el Habbal MH , Smith LJ , Elliott MJ , Strobel S. Cardiopulmonary bypass tubes and prime solutions stimulate neutrophil adhesion molecules . Cardiovasc Res 1997; 33: 209-215 .