title: Leucodepletion during cardiopulmonary bypass reduces blood transfusion and crystalloid requirements.
abstract: Cardiopulmonary bypass (CPB) is associated with the production of inflammatory responses, which can have significant influence on prognosis. We studied the effects of leucocyte-depletion filters on inflammatory parameters and early postoperative prognosis during coronary revascularization. Twenty patients undergoing elective coronary revascularization were randomly divided into two groups. Ten patients had leucocyte-depletion filters added to the CPB circuit (treatment group) and 10 were used as control cases (control group). Expression of CD11b on neutrophils, and production of myeloperoxidase and lactoferrin, were measured in arterial samples between induction and 3 h postbypass. In addition, clinical parameters were measured during inpatient recovery. CD11b neutrophil expression, and myeloperoxidase and lactoferrin production, were found to be upregulated during CPB and then to decline to preoperative levels by the third postoperative hour. Blood transfusion requirements were reduced in the treatment group, equalling 1.5 +/- 1.2 units, compared to 2.7 +/- 1.1 units for the control group (p value = 0.034) and so were the volumes of crystalloid infused during the first 24 h postoperatively, equalling 3.9 +/- 1.21 in the treatment group and 3.3 +/- 0.71 in the control group (p value = 0.021). Overall, the application of leucocyte depletion produced an early clinical advantage, underlining the need for an improved understanding and manipulation of the inflammatory response to CPB.
authors.affiliation: Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Stefanou
authors.forename: T
authors.initials: T
authors.lastname: Gourlay
authors.forename: G
authors.initials: G
authors.lastname: Asimakopoulos
authors.forename: K M
authors.initials: KM
authors.lastname: Taylor
mesh_terms: D015415:Biomarkers; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000295:instrumentation; D000077324:Crystalloid Solutions; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005374:Filtration; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D007552:Isotonic Solutions; D007781:Lactoferrin / Q000097:blood; D007958:Leukocyte Count; D007962:Leukocytes; D008212:Lymphocyte Depletion; D016177:Macrophage-1 Antigen / Q000097:blood; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects; D009504:Neutrophils / Q000737:chemistry / Q000201:enzymology; D009195:Peroxidase / Q000097:blood; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011184:Postoperative Period; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D016177:Macrophage-1 Antigen; D010952:Plasma Substitutes; D009195:Peroxidase; D007781:Lactoferrin