Leukocyte filter enhances neutrophil activation during combined aortic valve and coronary artery bypass surgery.
OBJECTIVE
Cardiopulmonary bypass-induced systemic inflammatory reaction involving the expression of neutrophil surface adhesion molecules is the main mechanism leading to myocardial ischemia-reperfusion injury as well as multiorgan dysfunction. Patients undergoing prolonged cardiopulmonary bypass are especially at risk in this regard. The aim of this prospective, randomized study was to evaluate the impact of continuous leukocyte filtration on the perioperative expression of neutrophil adhesion molecules along with the markers of systemic inflammation during combined coronary artery revascularization and aortic valve surgery due to aortic stenosis.


METHODS
Twenty patients scheduled for combined coronary artery revascularization and aortic valve surgery due to aortic stenosis were randomized to undergo cardiopulmonary bypass with or without a leukocyte filter (LeukoGuard LG6). The expression of neutrophil adhesion molecules and proinflammatory cytokine response were measured.


RESULTS
The use of the leukocyte filter significantly increased neutrophil CD11b expression (Pg = .003) compared to the control group, which was followed by a faster rise in interleukin-6 levels 5 minutes (median, 125 versus 34 pg/mL) and 2 hours after cardiopulmonary bypass (median, 158 versus 92 pg/mL, Pt x g < .001), respectively. No marked differences in terms of levels of CD11a, CD62L, cardiac troponin-I, or oxyhemodynamics were observed.


CONCLUSIONS
The observed increased neutrophil activation and enhanced inflammatory response do not support the use of continuous leukofiltration in patients undergoing prolonged cardiopulmonary bypass.
Koskenkari
Juha K
JK
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
Rimpiläinen
Jussi
J
Ohman
Hanna
H
Surcel
Heljä-Marja
HM
Vainionpää
Vilho
V
Biancari
Fausto
F
Ala-Kokko
Tero
T
Juvonen
Tatu
T
D000368:Aged; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007962:Leukocytes / Q000276:immunology* / Q000473:pathology; D008297:Male; D018375:Neutrophil Activation / Q000276:immunology*; D015427:Reperfusion Injury / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D016896:Treatment Outcome