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Cardiopulmonary bypass activates enzymes mediating acute inflammation and organ injury (ie, nitric oxide synthase, matrix metalloproteinase-9, and matrix metalloproteinase-2). Decreased tissue inhibitor of metalloproteinase-4 expression allows relatively unopposed increases in matrix metalloproteinase tissue activity. We postulate that these changes play a role in the pathogenesis of heart dysfunction after bypass surgery.

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Depletion of activated neutrophils by a filter during cardiac valve surgeryPurpose: To determine whether inclusion of a neutrophil-speciflc filter into the extracorporeal circuit during open heart valve surgery alters postoperative outcomes.Methods: Convenience sampling of 24 patients undergoing elective open heart valve surgery between July 1993 and June 1994. Patients were randomized to a neutrophil-specific filter (n= I I) orto a standard blood filter (n= 13) during cardiopulmonary bypass.Results: Neutrophil-specific filter diminished (P <0,02) the expression of CD 18, a neutrophil surface adhesion molecule, at I (84,5 + 4.2 vs 94,8 _+ 3.8%), 4 (80.0 -4.2 vs 95. I ___ 3.9%) and 24 hr (75.2 + 4.2 vs 98,2 _+ 3.9%) post-operatively compared with standard filter. Total white blood cell count, neutrophil count, and proinflammatory cytokines (IL-6, IL-8) were similar between groups at all times. Measured outcomes including: F'aO 2, cardiac index, ejection fraction, haemodynamic variables, use of inotropes, spirometry (FEV~. FVC), and hospitalization duration were similar between groups.Conclusions: Inclusion of the neutrophil filter during open heart valve surgery selectively depletes activated neutrophils. There were no other detectable differences between the two groups and the use of a neutrophilspecific filter in routine clinical practice for patients undergoing open heart valve surgery is not supported.Objectif : D&erminer si I'ajout au circuit extracorporel d'un filtre sp&ifique aux neutrophiles pendant une chirurgie valvulaire modifiait les r&ultats de I'intervention M&hodes : Un &hantillonnage de 24 patients subissant une intervention valvulaire ~ coeur ouvert entre juillet 1993 et juin 1994. Les patients ont ~t~ r~partis al~atoirement ~ un circuit extracorporel incluant un filtre sp&i-fique aux neutrophites (n = I I) ou un filtre standard (n= 13).R&ultats : Le filtre sp&ifique aux neutrophiles a diminu~ I'expression de CDI 8, une mol&ule adh&ive de surface, une heure (84,5 + 4,2 vs 98,8 _ 3,8%), quatre heures (80 +-4,2 vs 95,1 +_ 3,9%) et 24 heures (75,2 +_ 4,2 vs 98,2 -+ 3,9%) apr~s I'op&ation comparativement au flltre standard. Le d&ompte total des globules blancs, des neutrophiles et des cytokines pro-inflammatoires (IL-6, IL8) &aient ~ tous les moments identiques entre les groupes. Les mesures de r&ultats incluant la PaO 2, I'index cardiaque, la fraction d'~jection, les donn~es h~modynamiques, I'utilisation d'inotropes, la spirom~trie (VEMS, CVF) et la dur~e du s~jour hospitalier ~taient identiques entre les groupes, Conclusion : !Lajout d'un filtre sp&ifique aux neutrophiles pendant la chirurgie ~ coeur ouvert ~puise s~lec-tivement les neutrophiles activ~s. Aucune autre diff&ence n'est discernable entre les groupes, l'utilisation courante de filtres sp&ifiques aux neutrophiles en clinique chez des patients soumis ~ une chirurgie valvulaire coeur ouvert n'est pas justifi6e.