Neutrophil depletion reduces myocardial reperfusion morbidity

Palatianos, George M.; Balentine, Gilbert; Papadakis, E.; Triantafillou, Constantine D.; Vassili, Mary I.; Lidoriki, Angela; Dinopoulos, A.; Astras, George

doi:10.1016/j.athoracsur.2003.10.004

Cited by 40 publications

(37 citation statements)

References 35 publications

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“…Nearly all investigators measured CK-MB, and from 1998 simultaneously measured Troponin Tor I as clinical markers of myocardial damage. Many studies demonstrated that release of CK-MB and Troponin is diminished in those patients in whom cardioplegia is leukodepleted, regardless of whether they are elective patients [71,[79][80][81], transplant patients [82], emergency cases [11] or patients with pre-operative myocardial dysfunction [83]. Contrary to that, Pala et al (1995) and Browning et al (1999) …”

Section: Does Leukocyte Filtration Of Blood Cardioplegia Improve Clinmentioning

confidence: 94%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.

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Section: Does Leukocyte Filtration Of Blood Cardioplegia Improve Clinmentioning

confidence: 94%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…Neutrophils are early responders after an inflammatory insult, which are able to produce potent cytokines and chemokines including tumour necrosis factor (TNF)-α, interleukin (IL)-1, IL-6 and IL-8 (Adrie and Pinsky 2000). Upon activation, they also release reactive oxygen species and proteases that may damage the microcirculation, exacerbating local ischemia-reperfusion injury (Palatianos et al 2004). Importantly, transcriptional profiles of circulating leukocytes after CPB-assisted (on-pump) cardiac surgery suggest that the inflammatory focus is localized in the peripheral tissues, not in the haematopoietic compartment (Tomic et al 2005).…”

Section: Systemic Inflammatory Responses After On-pump Cardiac Surgerymentioning

confidence: 99%

Hsp70 and cardiac surgery: molecular chaperone and inflammatory regulator with compartmentalized effects

Jong

Schadenberg

Jansen

et al. 2009

Cell Stress and Chaperones

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Open heart surgery is a unique model to study the interplay between cellular injury, regulation of inflammatory responses and tissue repair. Stress-inducible heat shock protein 70-kDa (Hsp70) provides a molecular link between these events. In addition to molecular chaperoning, Hsp70 exerts modulatory effects on endothelial cells and leukocytes involved in inflammatory networks. Hsp70 residing in the intracellular compartment is part of an inhibitory feedback loop that acts on nuclear factor kappaB (NF-kappaB). In contrast, extracellular Hsp70 is recognized by multiple germline-encoded immune receptors, e.g., Toll-like receptor (TLR) 2, TLR4, LOX-1, CD91, CD94, CCR5 and CD40. Hsp70 is thereby able to enhance chemotaxis, phagocytosis and cytolytic activity of innate immune cells and stimulate antigen-specific responses. These apparent contradictory pro- and anti-inflammatory effects of endogenous Hsp70 in the context of cardiac surgery are still not fully understood. An all-embracing model of the compartmentalized effects of endogenous Hsp70 in the orchestration of inflammatory responses in cardiac surgery is proposed.

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“…On the other hand, responses to another endothelium-dependent vasodilator, ADP, are unchanged after cardioplegic arrest, suggesting that the upregulation of VEGF receptors on the coronary endothelium is selective and may play a role in Leukocyte-depleted cardioplegic solutions. Were effective in decreasing troponin T release and the incidence of postoperative low cardiac output in a trial of 160 patients [135] Antibodies to adhesion molecules. No clinical data.…”

Section: Cytokine Releasementioning

confidence: 99%

Vasomotor dysfunction after cardiac surgery

Ruel

Khan

Voisine

et al. 2004

European Journal of Cardio-Thoracic Surgery

106

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Cardiopulmonary bypass and cardioplegic arrest, which allow for support of the circulation and stabilization of the heart during cardiac procedures, are still used for the vast majority of cardiac operations worldwide. However, in addition to a well-recognized systemic inflammatory response, cardiopulmonary bypass and cardioplegic arrest elicit complex, multifactorial vasomotor disturbances that vary according to the affected organ bed, with reduced vascular resistances in the skeletal muscle and peripheral circulation, and increased propensity to spasm in the cardiac, pulmonary, mesenteric and cerebral vascular beds. This article outlines the nature, mechanistic basis, and clinical correlates of the vasomotor alterations encountered in patients undergoing cardiac surgery using cardiopulmonary bypass and cardioplegic arrest.

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Neutrophil depletion reduces myocardial reperfusion morbidity

Cited by 40 publications

References 35 publications

The effects of various leukocyte filtration strategies in cardiac surgery

The effects of various leukocyte filtration strategies in cardiac surgery

Hsp70 and cardiac surgery: molecular chaperone and inflammatory regulator with compartmentalized effects

Vasomotor dysfunction after cardiac surgery

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