What is the Role of Leukocyte Depletion in Cardiac Surgery?

Lim, Hou Kiat; Anderson, Joanna; Leong, Jee-Yoong; Pepe, Salvatore; Salamonsen, Robert F.; Rosenfeldt, Franklin

doi:10.1016/j.hlc.2007.01.003

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…The most frequent reason for using LD filtration is the belief that it reduces complications in those patients who are most vulnerable to the adverse effects of CPB, in particular, patients with pre‐existing pulmonary disease or cases of long duration. This opinion has been expressed recently within the literature (13). The frequency of arterial line LD filtration in our survey (19%) is very similar to that seen in a 2004 survey of North American practice (17%) (10) demonstrating that in both countries, there is a sizable minority of perfusionists, surgeons, and anesthetists who believe this to be a beneficial intervention.…”

Section: Discussionsupporting

confidence: 87%

Variations in the Application of Various Perfusion Technologies in Great Britain and Ireland—A National Survey

et al. 2010

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In an attempt to reduce the negative sequelae of cardiopulmonary bypass (CPB), a variety of new technologies have been created. This study investigates variations in the application of these technologies throughout Great Britain and Ireland (GB & I). All perfusion departments within GB & I were surveyed about equipment and technologies used in CPB. Eighty-five percent of units use a standard arterial line filter in all cases. Forty percent of units occasionally use leukocyte-depleting filters in various sites within the circuit. Sixteen percent always use some element of heparin-bonded circuit, but 62% never use them. Twenty-five percent use solely rotary pumps, 18% use solely centrifugal pumps, and 56% use both. Finally, 20% are now using minimal extracorporeal circulation in certain clinical scenarios. These decisions are most frequently affected by clinician preference and cost. This survey has highlighted significant variation in the utilization of various technologies used in CPB. While some variation between centers is to be expected, as innovative technologies are adopted at varying rates, surveys such as this are useful for alerting clinicians to gaps between evidence-based knowledge and clinical practice.

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Section: Discussionsupporting

confidence: 87%

Variations in the Application of Various Perfusion Technologies in Great Britain and Ireland—A National Survey

et al. 2010

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“…59 Furthermore, our sensitivity analysis of studies including high-risk patients showed a reduction in the duration of ventilatory support in the treated group, supporting those who have suggested that high-risk patients may have the most to gain from the attenuation of the inflammatory response that leukodepleting filters potentially cause. 55,66 This meta-analysis demonstrates that the efficacy of leukocyte depletion remains less impressive than might have been anticipated from our knowledge of the pathophysiology of the inflammatory response associated with CPB. Why this should be the case remains unclear.…”

Section: Discussionmentioning

confidence: 96%

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

et al. 2008

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Pulmonary injury mediated by activated leukocytes is a recognized complication of cardiopulmonary bypass. The aim of this paper is to systematically analyze the effects of systemic leukofiltration within the cardiopulmonary bypass circuit on pulmonary injury and related clinical outcomes. We performed a systematic search to identify randomized controlled trials reporting on the effects of systemic leukofiltration on respiratory parameters. Random effect meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity and subgroup analyses were undertaken to evaluate study heterogeneity. Incorporating 995 patients, 21 studies satisfied the inclusion criteria. Systemic leukofiltration significantly increased the PaO2/FiO2 ratio within 12 hours of bypass cessation, (weighted mean difference (WMD), 25.97; 95% confidence interval (CI), 3.41-48.53; p = 0.02) but this effect was lost by 24 hours (WMD, 12.98; 95% CI, -7.93-33.89; p = 0.22). Leukofiltration significantly reduced the duration of ventilatory support postoperatively (WMD, -2.11 hours; 95% CI, -0.65 to -3.58; p = 0.005), but had no impact on postoperative chest infection, intensive care length of stay or hospital length of stay. The heterogeneity of the included studies was high, due to poor quality study design and failure to include patients at high risk of pulmonary complications. Systemic leukofiltration may attenuate bypass-related lung injury in the early postoperative period, but this does not seem to translate to clinically significant differences in outcomes.

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“…3 The interaction between activated leukocytes and endothelia is important in the pathogenesis of ischaemia-reperfusion injury. 4 Leukocyte activation may arise from the complex interaction between the leukocytes and the endothelium of the ischaemic organ (e.g. heart) and contact with the artificial surfaces of the cardiopulmonary bypass circuit.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Blood cardioplegia in cardiac surgery contains leukocytes, which causes the inflammatory reaction and promotes myocardial reperfusion injury. The removal of leukocytes from the cardioplegia line, using specialized filters, has been proposed as one of the effective methods in attenuating the inflammatory response. We performed a two-level search to identify randomized, controlled trials concerning the effects of leukocyte-depleted blood cardioplegia on myocardial reperfusion injury. Sixteen studies, comprising 738 patients, met the selection criteria. There are significant reductions in creatinine kinase isoenzyme MB (CK-MB) during 4-8h postoperatively (SMD - 0.577; 95% CI -0.795 to -0.358; p=0.000), CK-MB peak (SMD - 0.713; 95% CI -1.027 to -0.400; p=0.000), troponin in the period of 4-8h postoperatively (SMD - 0.502; 95% CI -0.935 to -0.069; p=0.023), troponin peak (SMD - 0.826; 95% CI -1.373 to -0.279; p=0.003) and inotropic support (RR, 0.500; 95% CI 0.269 to 0.931; p=0.029). Leukocyte-depleted blood cardioplegia may reduce myocardial reperfusion injury in the early postoperative period, but there has been no evidence to support the clinically significant difference. Larger and more precise randomized control trials are needed to further elucidate the cardioprotective effects of cardioplegia leukofiltration.

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What is the Role of Leukocyte Depletion in Cardiac Surgery?

Cited by 15 publications

References 38 publications

Variations in the Application of Various Perfusion Technologies in Great Britain and Ireland—A National Survey

Variations in the Application of Various Perfusion Technologies in Great Britain and Ireland—A National Survey

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

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

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