The effect of leukocyte-depleted blood cardioplegia in patients with severe left ventricular dysfunction: a randomized, double-blind study.
BACKGROUND
The propensity for leukocytes to cause reperfusion injury in patients undergoing heart surgery is widely accepted. Reperfusion injury may result in myocardial damage and unfavorable operative outcome, especially in patients with severely reduced ejection fractions. This study was performed to evaluate the impact of leukocyte filtration on the postoperative course of patients undergoing coronary bypass surgery.


METHODS
Thirty-two patients with coronary artery disease and left ventricular ejection fraction less than 35% were included in this double-blind, randomized study. Two serial leukocyte removal filters (Pall BC1B filter [Pall Biomedical, Portsmouth, England], group F, 15 patients) or two dummy filters (group C, 17 patients) were connected to the blood cardioplegia line. Leukocyte count, hemodynamic measurement, and transesophageal echocardiography were performed before and after cardiopulmonary bypass. Cardiac-specific enzymes were analyzed from arterial blood during the first 72 hours and from coronary sinus blood 30 and 60 minutes after aortic unclamping.


RESULTS
Patient characteristics were similar in the two groups (ejection fraction 20.9% +/- 4.3% in group C and 21.1% +/- 4.8% in group F; P =.773). No early death or perioperative myocardial infarction occurred. Leukocyte count, hemodynamic parameters, cardiac troponin T, cardiac troponin I, and creatine kinase MB mass levels in arterial blood were similar in the two groups. Group F showed lower release of cardiac troponin T from the coronary sinus 30 minutes after unclamping of the aorta (group F, 0.263 +/- 0.12 ng/mL; group C, 0.6 +/- 0.32 ng/mL; P =.005). Lower doses of dopamine were necessary after cardiopulmonary bypass (group F, 0.36 +/- 0.11 mg x kg(-1) x min(-1); group C, 0.49 +/- 0.14 mg x kg(-1) x min(-1); P =.003). A moderate increase in ejection fraction was observed at 30 minutes in both groups (group F, 30.3% +/- 6.2%; group C, 28.0% +/- 6.3%; P =.239) and a significant increase at 60 minutes in group F (group F, 32.5% +/- 6.0%; group C, 27.4% +/- 7.5%; P =.012).


CONCLUSIONS
These results indicate that serial leukocyte filters connected to the blood cardioplegia line decrease myocardial cell injury and may therefore help to improve outcome of patients with severely depressed ejection fractions undergoing coronary artery bypass grafting.
Roth
M
M
Departments of Thoracic and Cardiovascular Surgery and Anesthesiology, Kerckhoff-Clinic Foundation, Bad Nauheim, Germany. Matthias.Roth@kerckhoff.med.uni-giessen.de
Kraus
B
B
Scheffold
T
T
Reuthebuch
O
O
Klövekorn
W P
WP
Bauer
E P
EP
D000368:Aged; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D005374:Filtration; D006439:Hemodynamics; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D007937:Leukapheresis / Q000379:methods*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000601:surgery*
D002314:Cardioplegic Solutions; D007527:Isoenzymes; D014336:Troponin; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form