Leukocyte depleting filter attenuates myocardial injury during elective coronary artery bypass surgery.
BACKGROUND
Ischemia-reperfusion injury secondary to leukocyte activation has been widely recognized as one of the most relevant mechanism leading to postoperative organ dysfunction occurring after a period of ischemia. The aim of the present study was to evaluate in a prospective, randomized study, the value of leukocyte depleting filter in patients undergoing elective coronary artery bypass surgery.


METHODS
Twenty patients scheduled for elective on-pump coronary artery bypass surgery were randomized to undergo cardiopulmonary bypass either with a leukocyte depleting filter incorporated in the extracorporeal circulation arterial line or without a filter.


RESULTS
The main finding of this study was the significantly lower postoperative concentrations of cardiac troponin I in the leukocyte filter group (Tests of between-subjects effects: p = 0.024). There were also slightly better cardiac indices in the leukocyte filter group. A larger amount of blood units was infused intra- and postoperatively in patients undergoing cardiopulmonary bypass with leukocyte filtration (median, 600 [IQR, 0-1200] vs. 0 [IQR, 0-600], p = 0.08). Two patients in the leukocyte filter group underwent reoperation for bleeding but none in the control group (p = 0.48). Intra-and postoperative platelet count was lower in the leukocyte filter group (Tests of between-subjects effects: p = 0.08). Despite a significant increased concentration of C-reactive protein on the first postoperative day in the control group (p = 0.029), repeated-measures analysis failed to show any significant increase during the study period (p = 0.33).


CONCLUSIONS
The results of this study suggest a myocardial protective effect of leukocyte filter in the setting of elective coronary artery bypass surgery.
Koskenkari
Juha
J
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland. juha.koskenkari@fimnet.fi
Rimpiläinen
Jussi
J
Biancari
Fausto
F
Surcel
Heljä-Marja
HM
Kaukoranta
Päivi
P
Kiviluoma
Kai
K
Ala-Kokko
Tero
T
Juvonen
Tatu
T
D000368:Aged; D002097:C-Reactive Protein; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D007962:Leukocytes; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors
D002097:C-Reactive Protein