Use of leukocyte-depleting filters during cardiac surgery with cardiopulmonary bypass: a review.
Numerous researchers and clinicians have shown that cardiopulmonary bypass (CPB) plays a large role in the initiation of the systemic inflammatory response during cardiac surgery. The activation of leukocytes during this process has been implicated as one of the major contributors to multi-organ dysfunction experienced by some patients after cardiac surgery. Thus, in an attempt to attenuate the systemic inflammatory response and to reduce the amount of activated leukocytes from the systemic circulation during CPB, leukocyte-depleting filters were developed in the early 1990s. Since the clinical introduction of these filters into the CPB circuit, several articles have been published evaluating the effectiveness of leukocyte filtration; however, the results have been conflicting. This article will review some of the most recent literature, approximately 40 papers published within the past 10 years, regarding the use of leukocyte-depleting filters during CPB and its effectiveness in preserving organ function. In addition, the effect of different filtration strategies and the effectiveness of the filter to attenuate the systemic inflammatory response in combination with other mechanical and pharmaceutical strategies will be reviewed.
Boodram
Shalini
S
College of Health Sciences, Cardiovascular Sciences Program, Midwestern University, Gendale, AZ, USA. shalini.boodram@azwebmail.midwestern.edu
Evans
Ed
E
D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation*; D005374:Filtration / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation / Q000379:methods; D007962:Leukocytes; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control; D013903:Thoracic Surgery / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors