Leukocyte-depleted Continuous Blood Cardioplegia for Coronary Artery Bypass Grafting

Abstract

SUMMARYMany cardiac surgeries are performed with blood cardioplegia. However, some studies suggest that activated neutrophils form blood cardioplegia can cause reperfusion injury. In this study we assessed myocardial protection using a leukocyte-depleted cardioplegic solution.Patients undergoing elective coronary artery bypass grafting (CABG) with continuous blood cardioplegia were divided into two groups: the LD group, which received leukocyte-depleted blood cardioplegia (n = 11); and the control group, which received nonfiltered blood cardioplegia (n = 11). IL-6, IL-8, CK-MB, and troponin T were measured in the coronary sinus blood immediately after the release of the aortic cross-clamp. Cytokine concentrations were also measured upon the patient's return to the ICU. The total dopamine and dobutamine doses, hemodynamic measurements after surgery, and the leukocyte filtration rate were also measured.During antegrade cardioplegia infusion, leukocytes were almost completely removed (filtration rate: 85.8 ± 4.0%). However, during terminal warm cardioplegia, leukocyte removal decreased (filtration rate: 39.9 ± 7.8%). Immediately after the release of the aortic cross-clamp, plasma CK-MB and troponin T concentrations were significantly lower in the LD group (17.7 ± 1.9 U / l and 0.017 ± 0.002 ng / ml, respectively) than in the control group (30.3 ± 3.6 U / l and 0.072 ± 0.029 ng / ml, respectively). The IL-6 and IL-8 concentrations were similar in the LD group and the control group. After the return to the ICU, the CK-MB and troponin T concentrations were similar in the two groups. No significant differences were found in the total doses of dopamine or dobutamine after surgery in the two groups (99 ± 77 vs 101 ± 128 µg / kg / min). No significant differences were found in the hemodynamic parameters after surgery in the two groups.In patients undergoing CABG with continuous blood cardioplegia, leukocytedepleted blood cardioplegic solution may attenuate reperfusion injury. (Jpn Heart J 2000; 41: 425-433)

The effects of various leukocyte filtration strategies in cardiac surgery

“…vs (2) have demonstrated a significantly lower maximum dose of inotrope at weaning of CPB in the leukodepleted group, but in their later study could only replicate this in patients who had extended aortic cross clamp time [73]. Other investigators, who predominantly studied uncomplicated elective cases, found no significant difference in any post-operative haemodynamic parameter [70,71,76,78,81].…”

“…These papers are summarised in Table 2. Fourteen were randomised control trials, and in one case the study design is not clear [70].…”

The inflammatory response to CPB: the role of leukocyte filtration

“…28 Leukocyte-depleted blood cardioplegia in humans produced lower levels of CK-MB and troponin T in blood obtained from the coronary sinus after unclamping of the aorta, in comparison to patients receiving non-leukocyte-depleted cardioplegia. 29,30 Enzyme plasma levels were similar in both groups after completion of the operation. 29…”

Poster presentation 2002

“…Q Chen a , S Shepard a , V Clinton b a Southampton University Hospital, Tremona Road, Southampton, Hants, UK; b DeMontfont University, The Gateway, Leicester, LE1 9BH, UK The removal of leukocytes from blood cardioplegia during cardiopulmonary bypass (CPB) has been demonstrated to improve myocardial protection during cardiac surgery. 1,2 This study was conducted to evaluate the filtration mechanism of the blood cardioplegia filter media (BC1B Pall Biomedical, Portsmouth, UK).…”