Myocardial protection with and without leukocyte depletion: a comparative study on the oxidative stress.
We tested the hypothesis that controlled reperfusion with leukocyte-depleted blood could improve myocardial protection by reducing the oxidative stress in patients undergoing myocardial revascularization. Thirty-four patients receiving antegrade/retrograde blood cardioplegia were divided into: group A: 11 patients with ejection fractions (EF) less than 35%, treated with leukocyte-depleted controlled blood reperfusion, group B: 11 patients with EF less than 35% in whom no leukocyte depletion was performed, group C: 6 patients with EF more than 45% treated as group A and group D: 6 patients with EF more than 45% without leukocyte depletion. To asses the oxidative stress, we evaluated total, total oxidized (GSSX), and reduced glutathione (GSH) in coronary sinus plasma, immediately before cross-clamping the aorta (T0), and at 0 (T1), 15 (T2) and 30 (T3) min after unclamping it. In groups A and B a significant shift towards oxidation of redox status of glutathione (GSH/GSSX) at T1 vs T0 was observed. Glutathione redox ratio remained low in group B while in group A it returned to the basal value at T2 with a significant difference from group B at T2 and T3. No differences were observed between groups C and D. In conclusion, our data show that leukocyte-depleted reperfusion can afford a better myocardial protection in patients with left ventricular dysfunction, while it seems unnecessary in patients with normal EF.
Pala
M G
MG
Institute for Cardiovascular and Respiratory Diseases, University of Milan, Italy.
Paolini
G
G
Paroni
R
R
De Veechi
E
E
Gallorini
C
C
Stefano
P L
PL
Di Credico
G
G
Zuccari
M
M
Galli
L
L
Agape
V
V
D000368:Aged; D001769:Blood; D002302:Cardiac Output; D002303:Cardiac Output, Low / Q000601:surgery; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery; D005978:Glutathione / Q000031:analogs & derivatives / Q000097:blood; D019803:Glutathione Disulfide; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D007937:Leukapheresis; D008875:Middle Aged; D010084:Oxidation-Reduction; D018384:Oxidative Stress / Q000502:physiology*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000601:surgery
D005978:Glutathione; D019803:Glutathione Disulfide