Leukocyte depletion during cardiac surgery with extracorporeal circulation in high risk patients |
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| Authors: | F. Bakhtiary A. Moritz P. Kleine O. Dzemali A. Simon H. Ackermann S. Martens |
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| Affiliation: | (1) Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, 60596 Frankfurt/Main, Germany;(2) Department of Biomedical Statistics of Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany;(3) Department of Thoracic and Vascular Surgery of “Oststadt- Heidehaus” Hospital, Hannover, Germany |
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| Abstract: | Background: Cardiopulmonary bypass is associated with systemic inflammation that may contribute to increased perioperative mortality. Depletion of circulating leukocytes may reduce the inflammatory response. We studied the effect of a leukocyte depleting filter on leukocyte activation during cardiopulmonary bypass in high risk patients. Methods: Fifty patients undergoing coronary artery bypass grafting with a preoperative high risk were randomly placed in an arterial line leukocyte filter group (n = 25) with a leukocyte depleting filter. Blood sampling took place from the arterial line to analyze polymorphnuclear elastase and myeloperoxidase at six time points, including: A) before the induction of anesthesia, B) before the induction of the cardiopulmonary bypass C) 1 min after the release of the aorta clamp, D) the end of the operation, E) 1 h postoperative, and F) 24 h postoperative. Results: Levels of polymorphonuclear elastase, (PMNE), and myeloperoxidase (MPO) were found to be higher after the release of the aortic cross clamp in the leukocyte filter group; these levels remained elevated until 24 hours after surgery and were high in comparison to preoperative baseline levels. The differences in PMNE between both groups at time points C and D (p < 0.005) and E (p < 0.05) were statistically significant. The serum levels of the S-100B and neuron specific enolase (NSE) were found to be elevated between time points C and E in both groups without statistical significance. The in-hospital mortality was 16% (4 patients) in leukocyte filter group and 4% in control group (1 patient). Conclusions: Interestingly, the activation of neutrophils was more pronounced in the LF group. The use of a leucocyte depleting filter was not advantageous for this patient cohort for clinical or biomedical endpoints. Received 17 February 2008; returned for revision 21 May 2008; received from final revision 6 August 2008; accepted by M. Katori 8 August 2008 |
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| Keywords: | KeywordHeading" >: Cardiac Surgery leukocyte depletion neutrophils |
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