Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?
OBJECTIVE
The powerful precept of preoperative risk assessment has been applied to compare the efficacy of leukofiltration techniques for high-risk cohorts with the documentation of broad indicators of systemic inflammation.


METHODS
Forty high risk patients were prospectively assigned to four perfusion protocols; the first group (n=10): Polyethyleneoxide (PEO) based heparin bonded extracorporeal circuits (ECC) + Continuous Leukocyte filtration; the second group (n=10): uncoated ECC + leukofiltration; the third group (n=10): PEO based heparin bonded ECC without leukofiltration; and control (n=10). Blood samples were obtained at the following intervals: Baseline (T1), on cardiopulmonary bypass (CPB) (T2), Cross clamp (T3), off CPB (T4), Intensive care unit-24 h (ICU24) (T5), ICU48 (T6).


RESULTS
Tumor Necrosis Factor-alpha levels were significantly lower in Group 1 at T3, T4 (p<0.05) vs. control. Procalcitonin levels were significantly lower in Group 1 at T5, T6 (p<0.05) vs. control. Creatinine kinase-MB levels in coronary sinus blood demonstrated well preserved myocardium in filtered+coated (Group 1) and coated groups (Group 3) (p<0.05). Matrix metallopeptidase- 9 and D-Dimer levels in filtered+coated group were significantly lower at T5 and T6 vs. control (p<0.05).


CONCLUSIONS
Leukocyte filtration on coated surfaces alleviated systemic inflammatory response with a better clinical outcome in high risk patients.
Kiliç
D
D
Department of Infectious Diseases and Clinical Microbiology, University of Kirikkale, School of Medicine, Kirikkale, Turkey. kilicd@gmail.com
Gunaydin
S
S
Kisa
U
U
Sari
T
T
Deveci
O
O
Zorlutuna
Y
Y
D000925:Anticoagulants / Q000627:therapeutic use; D001424:Bacterial Infections / Q000097:blood* / Q000276:immunology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology; D007958:Leukocyte Count; D047589:Leukocyte Reduction Procedures / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D000925:Anticoagulants; D014409:Tumor Necrosis Factor-alpha; D006493:Heparin