title: Leukocyte filtration of blood cardioplegia attenuates myocardial damage and inflammation.
abstract: OBJECTIVE
  Leukocyte filtration of blood cardioplegia (cLkF) is postulated to reduce ischaemia-reperfusion myocardial injury. Contradictory results have been published and few studies have addressed perioperative cytokine leakage and haemodynamic status after LkF.
  
  
  METHODS
  Thirty patients undergoing isolated aortic valve replacement were randomized to cLkF (cLkF-Group) or to standard cold blood cardioplegia (S-Group). Troponin I (TnI) and lactate were sampled from the coronary sinus at reperfusion. Peripheral TnI and lactate were collected preoperatively at admission, and in the intensive care unit (ICU) at 8, 12, 36 and 60 h postoperatively. Cardiac index (CI), indexed systemic vascular resistances, cardiac cycle efficiency (CCE) and central venous pressure (CVP) were registered preoperatively, at admission to the ICU and at the 6th, 12th, 18th, 24th and 36th postoperative hour. IL-6, IL-8, TNF-alpha and IL-10 were sampled preoperatively, at reperfusion, on admission to the ICU and the 6th, 18th and 24th postoperative hours.
  
  
  RESULTS
  The cLkF group showed lower TnI (2.4 ± 0.4 vs. 5.1 ± 0.8 μg/l, P = 0.0001) and lactate (0.9 ± 0.1 vs. 1.6 ± 0.2 mmol/l, P = 0.0001) from the coronary sinus at reperfusion. TnI levels (group-P = 0.0001, group time-P < 0.0001) and lactate (group time-P = 0.001) remained lower postoperatively after cLkF. Ventricular defibrillation at aortic declamping was less common in the cLkF-Group (33.3% vs. S-Group: 93.3%; P = 0.002). Cytokines demonstrated significant postoperative leakage (time-P = 0.0001 in both groups for IL-6, IL-8, TNF-alpha, IL-10), with lower pro-inflammatory (IL-6 group-P = 0.0001, group time-P = 0.0001; IL-8 group-P = 0.0001, group time-P = 0.007; TNF-alpha group-P = 0.0001; group time-P = 0.012) and higher anti-inflammatory cytokine secretion after cLkF (IL-10 group-P = 0.005). Perioperative haemodynamic indices proved to be similar between the two groups (group-P = NS for CI, SVRI, CCE and CVP).
  
  
  CONCLUSIONS
  cLkF during blood cardioplegia attenuates myocardial ischaemia/reperfusion injury and reduces perioperative leakage of TnI, lactate and pro-inflammatory cytokines. These data did not result in a better haemodynamic status.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. frankono@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Tiziano
authors.initials: T
authors.lastname: Menon
authors.forename: Enrico
authors.initials: E
authors.lastname: Amoncelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Campanella
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Pechlivanidis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D019344:Lactic Acid / Q000097:blood; D047589:Leukocyte Reduction Procedures / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D059035:Perioperative Period; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D016207:Cytokines; D019210:Troponin I; D019344:Lactic Acid