title: Leukocyte filter enhances neutrophil activation during combined aortic valve and coronary artery bypass surgery.
abstract: 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.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Juha K
authors.initials: JK
authors.lastname: Koskenkari
authors.forename: Jussi
authors.initials: J
authors.lastname: Rimpiläinen
authors.forename: Hanna
authors.initials: H
authors.lastname: Ohman
authors.forename: Heljä-Marja
authors.initials: HM
authors.lastname: Surcel
authors.forename: Vilho
authors.initials: V
authors.lastname: Vainionpää
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Tero
authors.initials: T
authors.lastname: Ala-Kokko
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
mesh_terms: 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