title: Leukocyte depletion during cardiac surgery with extracorporeal circulation in high risk patients.
abstract: BACKGROUND
  Cardiopulmonary bypass is associated with systemic inflammation that may contribute to increased perioperative mortality. Depletion of circulating leukocytes may reduce the inflammatory response. We studied the effect of a leukocyte depleting filter on leukocyte activation during cardiopulmonary bypass in high risk patients.
  
  
  METHODS
  Fifty patients undergoing coronary artery bypass grafting with a preoperative high risk were randomly placed in an arterial line leukocyte filter group (n = 25) with a leukocyte depleting filter. Blood sampling took place from the arterial line to analyze polymorphnuclear elastase and myeloperoxidase at six time points, including: A) before the induction of anesthesia, B) before the induction of the cardiopulmonary bypass C) 1 min after the release of the aorta clamp, D) the end of the operation, E) 1 h postoperative, and F) 24 h postoperative.
  
  
  RESULTS
  Levels of polymorphonuclear elastase, (PMNE), and myeloperoxidase (MPO) were found to be higher after the release of the aortic cross clamp in the leukocyte filter group; these levels remained elevated until 24 hours after surgery and were high in comparison to preoperative baseline levels. The differences in PMNE between both groups at time points C and D (p < 0.005) and E (p < 0.05) were statistically significant. The serum levels of the S-100B and neuron specific enolase (NSE) were found to be elevated between time points C and E in both groups without statistical significance. The in-hospital mortality was 16% (4 patients) in leukocyte filter group and 4% in control group (1 patient).
  
  
  CONCLUSIONS
  Interestingly, the activation of neutrophils was more pronounced in the LF group. The use of a leucocyte depleting filter was not advantageous for this patient cohort for clinical or biomedical endpoints.
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, 60596 Frankfurt/Main, Germany. farhad@bakhtiary.de
authors.forename: F
authors.initials: F
authors.lastname: Bakhtiary
authors.forename: A
authors.initials: A
authors.lastname: Moritz
authors.forename: P
authors.initials: P
authors.lastname: Kleine
authors.forename: O
authors.initials: O
authors.lastname: Dzemali
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: H
authors.initials: H
authors.lastname: Ackermann
authors.forename: S
authors.initials: S
authors.lastname: Martens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000276:immunology; D007432:Intraoperative Period; D007958:Leukocyte Count; D047589:Leukocyte Reduction Procedures / Q000379:methods*; D007962:Leukocytes; D008297:Male; D009195:Peroxidase / Q000378:metabolism; D012307:Risk Factors
chemical_list: D009195:Peroxidase