title: Clinical efficacy of two-phase leukocyte filtration in high-risk patients undergoing coronary revascularization with cardiopulmonary bypass.
abstract: The purpose of this study was to investigate the clinical outcome, inflammatory response and myocardial function in high-risk patients undergoing three different leukocyte depletion strategies. Over a four-month period, forty patients (EuroSCORE 6+) undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1 (N=10): Conventional circuits (ECC) + two leukocyte filters (LG6B, Pall, USA) with the method of two-phase (continuous + strategic) leukofiltration; Group 2 (N=10): ECC + single leukocyte filter with the method of continuous leukofiltration; Group 3 (N=10): ECC + single leukocyte filter with the method of strategic leukofiltration; Group 4 (N=10) CONTROL: ECC without leukocyte filtration. Blood samples were collected at T1: Baseline, T2: On CPB, T3: X-Clamp, T4: Off CPB, T5: ICU24 and T6: ICU48. Perioperative follow-up was thoroughly monitored. Leukocyte counts in double filter and strategic filtration groups demonstrated significant differences at T4 (p < .05 vs. control). TNFalpha levels were significantly lower in Group 1 at T4 and procalcitonin levels at T5 and T6 (p < .05 vs. control). CKMB levels demonstrated well preserved myocardium in double filter group (p < .05 vs. control). Brain natriuretic peptide levels in double filter group were significantly lower at T5 and T6 with respect to Group 2 (p <.05) and control (p <.001). Matrixmetallopeptidase 9 and D-Dimer levels in double filter group were significantly lower at T5 and T6 (p <.05 vs. control).Two-phase leukofiltration is associated with some compound benefit over continuous deployment in high-risk patients. A larger more powerful study than this pilot one is warranted for further evaluation.
authors.affiliation: Department of Cardiovascular Surgery, University of Kirikkale, Kirikkale, Turkey. sgunaydin@isnet.net.tr
authors.forename: Serdar
authors.initials: S
authors.lastname: Gunaydin
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.forename: Tamer
authors.initials: T
authors.lastname: Sari
authors.forename: Yaman
authors.initials: Y
authors.lastname: Zorlutuna
authors.forename: Terence
authors.initials: T
authors.lastname: Gourlay
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D001026:Coronary Artery Bypass; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007937:Leukapheresis / Q000295:instrumentation / Q000379:methods*; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation / Q000379:methods*; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D015427:Reperfusion Injury / Q000517:prevention & control*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form; D020780:Matrix Metalloproteinase 9