Leucocyte filtration during cardiopulmonary bypass hardly changed leucocyte counts and did not influence myeloperoxidase, complement, cytokines or platelets

Abstract

In some patients, coronary artery bypass surgery induces postoperative organ dysfunction despite an apparently adequate revascularization and good haemodynamic performance. This complication may be caused by activation of the body's inflammatory systems on blood contact with large foreign surfaces in the extracorporeal circuit. Activated leucocytes may play an important role in organ damage, and it is conceivable that leucocyte removal by filtration may decrease the potential side-effects of cardiopulmonary bypass (CPB). The aim of the present study was to investigate possible effects of leucocyte filtration during the whole CPB period in elective coronary artery bypass surgery on biochemical and clinical parameters. Forty patients were randomized to extracorporeal circulation using a leucocyte-depleting filter (group L, n = 20) or to extracorporeal circulation with no leucocyte filter (group C, n = 20). In the leucocyte-depleted group, the mean total white blood cell counts increased from 6.3 (95% confidence interval, 5.5-7.0) x 10(9)/l to 7.0 (5.7-8.3) x 10(9)/l during extracorporeal circulation and in the control group from 6.3 (5.2-7.3) x 10(9)/l to 8.5 (7.2-9.8) x 10(9)/l. The intergroup difference was not statistically significant (p = 0.84). A substantial increase in concentrations of interleukin-6, myeloperoxidase and complement activation products were observed in both groups without statistically significant intergroup differences. It is concluded that the leucocyte-depletion filter did not cause a significant reduction of circulating white blood cells during CPB, and there were no significant differences between the groups with respect to the inflammatory markers studied.

The effects of various leukocyte filtration strategies in cardiac surgery

“…Only eight studies within this section of the review did not record pre-and post-operative WCC. Of the 26 that did, 15 found no significant difference between filtered patients and controls at any point in the patients admission [9,22,23,27,[39][40][41][42][43][44][45][46][47][48][49][50]. The remaining 11 papers found reduced WCCs in the filtered group mainly during CPB, although these differences tended to disappear after CPB [10,26,35,[51][52][53].…”

“…IL-1, IL-6, IL-8 and TNF) during or after cardiac surgery [22,23,39,46,50,55]. The only study to show a significant effect utilized a venous line leukodepleting filter [10] and observed a significant decrease in IL-8 compared to controls.…”

“…However, all others studies utilising MDA as an outcome variable for systemic leukofiltration have shown no significant effect. [42] (1) C vs (2) LDALF 2 n/a n/a n/a n/a a, h, i, d, p, q 50 25 25 --n/a n/a --n/a [25] (1) C vs (2) n / a 9 ,1 0 ,1 1 H n / a n 2 8 7 7 6 8 n / a n / a n / a n / a n / a [23] (1) C vs (2) [35] (1) C vs (2) LDALF ? n/a 2 n/a n/a a, q, r, h 26 kinase-MB (CK-MB) and Troponin T or I.…”

“…One of the concerns regarding systemic leukodepletion is that simultaneous removal of platelets might adversely influence post-operative haemostasis [12]. However, a multitude of studies have shown leukocyte filtration to have no significant adverse impact on the degree of post-operative blood loss or the requirements for blood transfusion [9,23,46,49,53,56]. Contrary to this large body of evidence, Sahlman et al found chest drainage in the first 24 h to be significantly higher in the filtered group ( p < 0.05) [45], however this was not accompanied by an increased need for blood transfusion.…”

“…Initially work focused on molecular inflammatory mediators and a wide variety of markers of neutrophil activation [17,22,23]. However, later work measured biochemical markers of organ injury [24][25][26] and examined the impact of leukodepletion on post-operative clinical course and the hospital costs [11,[27][28][29][30].…”