Temporary leukocyte depletion reduces ventricular dysfunction during prolonged postischemic reperfusion.
Leukocyte depletion improves early postischemic ventricular performance in neonatal models of global myocardial ischemia. However, the rate of leukocyte reaccumulation after cardiopulmonary bypass and its subsequent impact on myocardial function is not known. This laboratory study examined the effect of leukocyte depletion on myocardial performance during the initial 6-hour period after bypass in an in situ, in vivo porcine model of neonatal cardiac surgery. Fifteen 3- to 5-day-old piglets (eight control and seven leukocyte depleted animals) were instrumented by placement of left ventricular short-axis sonomicrometry crystals and an intraventricular micromanometer catheter. Mechanical leukocyte depletion was achieved with Pall RC100 filters (Pall Biomedical, Inc., Fajardo, Puerto Rico) in the cardiopulmonary bypass circuit. Neonatal hearts were subjected to 90 minutes of hypothermic ischemia after a single dose of cold crystalloid cardioplegia. Two control animals died after the operation and were excluded from data analysis. Leukocyte filtration reduced the granulocyte count during initial myocardial reperfusion to 0.8% of control values. However, circulating granulocyte counts increased in leukocyte depleted animals throughout the postoperative period, reaching 68% of control values by 6 hours. Despite this rapid return of circulating granulocytes, animals subjected to leukocyte depletion had significantly better preservation of left ventricular performance (measured by preload recruitable stroke work, p < or = 0.02), left ventricular systolic function (measured by end-systolic pressure-volume relationship, p < or = 0.05), and ventricular compliance (p < or = 0.04) during the experiment. These changes in ventricular function were associated with a significant increase in left ventricular water content (p < or = 0.02) and tissue myeloperoxidase activity (p < or = 0.005) in control animals compared with leukocyte depleted animals. This study demonstrates that leukocyte depletion during initial reperfusion results in sustained improvement in postischemic left ventricular function despite the rapid return of granulocytes to the circulation.
Wilson
I C
IC
Department of Cardiac Surgery, Johns Hopkins Medical Institution, Baltimore, Md. 21205.
Gardner
T J
TJ
DiNatale
J M
JM
Gillinov
A M
AM
Curtis
W E
WE
Cameron
D E
DE
D000818:Animals; D000831:Animals, Newborn; D002315:Cardiopulmonary Bypass; D005374:Filtration / Q000295:instrumentation; D006098:Granulocytes / Q000502:physiology*; D007958:Leukocyte Count; D017202:Myocardial Ischemia / Q000276:immunology* / Q000503:physiopathology; D015425:Myocardial Reperfusion / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D016277:Ventricular Function, Left / Q000276:immunology*