Leucocyte-depleted Blood Cardioplegia

Abstract

The effect of the depletion of leucocytes from cardioplegic and initial myocardial reperfusion blood on the inflammatory response and myocardial protection in patients with unstable angina undergoing cardiopulmonary bypass (CPB) was studied. Patients were allocated randomly to a leucocyte-depleted (LD) group or a control group. The LD group received continuous retrograde LD isothermic blood cardioplegia and the control group received isothermic blood cardioplegia. Blood samples were collected at seven time-points before, during and after the procedure. Total leucocyte counts of cardioplegia blood in the LD group were significantly lower than in the control group, but systemic leucocyte and neutrophil counts after CPB did not differ between the groups. The levels of adhesion molecules, cytokines, elastase and malondialdehyde were significantly increased after CPB in both groups and reached peak values 2-6 h after surgery; no other significant differences were found. LD cardioplegia and myocardial reperfusion did not attenuate the endothelial and neutrophil-mediated components of the CPB-induced inflammatory response, which may lead to myocardial reperfusion injury.

Does leukocyte-depleted blood cardioplegia reduce myocardial reperfusion injury in cardiac surgery? A systematic review and meta-analysis

“…We finally identified 16 eligible studies on which to perform the meta-analysis. 15–30 Table 1 lists the main characteristics of these studies. In total, our meta-analysis included data on 738 patients, 373 (50.5%) of whom underwent leukocyte filtration in the cardioplegia line and 365 (49.5%) with a control filter.…”

“…Only one trial 15 had described a random component in the sequence generation process and was judged to have reported adequate allocation concealment for the other trials; 16–30 the methods reported were judged to be unclear on the basis of random sequence generation and allocation concealment. Twelve trials 15–19,21,22,24–26,28,29 did not blind of participants and personnel; however, it was believed that the outcome was unlikely to be influenced by the lack of blinding. Five trials 15,20,22,23,26,27,30 were blinded to outcome assessment and it was unclear for the others.…”

“…All the trials described main outcomes and no missing data seemed to influence the results. Two trials 15,16 had a potential source of bias related to the specific study design (the leukocyte-depleting filters were located to both cardioplegia line and arterial line).…”

“…First, two studies where cardioplegia leukofiltration was combined with arterial line leukofiltration may magnify the effects of leukofiltration of blood cardioplegia. 15,16 Second, the reduction in myocardial reperfusion injury appeared to be mainly in ischaemically compromised hearts or hearts with impaired left ventricular function, not in routine patients. 3 Czech et al 17 demonstrated that the effects were too weak to influence the outcome of patients with well-preserved left ventricular (LV) function, in line with suggestions by Reimer et al 32 that the role of leukocytes in myocardial reperfusion injury may be related to the degree of LV dysfunction.…”