Depletion of Neutrophils by Filter During Aortocoronary Bypass Surgery Transiently Improves Postoperative Cardiorespiratory Status

¹ From the Departments of Anesthesia and Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
² From the Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
³ From the Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
⁴ From the Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Study objective: To determine whether inclusion of a leukocyte specific filter into the extracorporeal circuit during aortocoronary bypass surgery alters postoperative cardiopulmonary function.

Design: Randomized, double-blinded control trial.

Setting: Tertiary care hospital.

Patients: Convenience sampling of patients undergoing elective aortocoronary bypass between October 1992 and June 1993.

Interventions: A total of 32 patients were randomized to a leukocyte specific filter (n=16) or to a standard blood filter (n=16) during the surgical procedure.

Measurements and results: White blood cell count in the standard filter group (12.2±3.6 10⁹/L) was higher (p=0.047) than in the leukocyte filter group (9.9±2.6 10⁹/L) at 4 h postoperatively but counts were similar (p=0.063) at 24 h (10.8±2.7 vs 8.9±2.6 10⁹/L, respectively). Leukocyte activation assessed by chemiluminescence was similar between groups at all measurement periods. We noted transient improvements (p<0.05) in intrapulmonary shunt (19±50% vs 24±9%) and mean blood pressure (85±8 vs 76±9 mm Hg, respectively) in the leukocyte filter group compared with the standard filter group, respectively. Otherwise there were no differences noted between groups.

Conclusions: Inclusion of a leukocyte filter during cardiopulmonary bypass caused transient cardiorespiratory improvement that was lost within 24 h and did not offer any significant clinical benefits.

Key Words: cardiopulmonary bypass • granulocytes • hemodynamics • intrapulmonary shunt

Submitted on June 1, 1994
Accepted on August 30, 2007

This article has been cited by other articles:

				O. Warren, C. Alexiou, R. Massey, D. Leff, S. Purkayastha, J. Kinross, A. Darzi, and T. Athanasiou The effects of various leukocyte filtration strategies in cardiac surgery Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 665 - 676. [Abstract] [Full Text] [PDF]

				D. C Whitaker, J. Stygall, M. J. Harrison, I. J Mackie, M. Kemp, J. Hooper, W. B Pugsley, and S. P Newman Leucocyte-depleting arterial line filtration does not reduce myocardial injury assessed by Troponin T during routine coronary artery bypass grafting using crossclamp fibrillation Perfusion, January 1, 2006; 21(1): 55 - 60. [Abstract] [PDF]

				S. G Raja and G. D Dreyfus Modulation of Systemic Inflammatory Response after Cardiac Surgery Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 382 - 395. [Abstract] [Full Text] [PDF]

				S. R. Leal-Noval, R. Amaya, A. Herruzo, A. Hernandez, A. Ordonez, A. Marin-Niebla, and P. Camacho Effects of a Leukocyte Depleting Arterial Line Filter on Perioperative Morbidity in Patients Undergoing Cardiac Surgery: A Controlled Randomized Trial Ann. Thorac. Surg., October 1, 2005; 80(4): 1394 - 1400. [Abstract] [Full Text] [PDF]

				R. F. Salamonsen, J. Anderson, M. Anderson, M. Bailey, G. Magrin, and F. Rosenfeldt Total Leukocyte Control for Elective Coronary Bypass Surgery Does Not Improve Short-Term Outcome Ann. Thorac. Surg., June 1, 2005; 79(6): 2032 - 2038. [Abstract] [Full Text] [PDF]

				M. Ilmakunnas, E. J. Pesonen, J. Ahonen, J. Ramo, S. Siitonen, and H. Repo Activation of neutrophils and monocytes by a leukocyte-depleting filter used throughout cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., April 1, 2005; 129(4): 851 - 859. [Abstract] [Full Text] [PDF]

				S W Sutton, A N Patel, V A Chase, L A Schmidt, E K Hunley, L W Yancey, R F Hebeler, E H Cheung, A C Henry III, T P Meyers, et al. Clinical benefits of continuous leukocyte filtration during cardiopulmonary bypass in patients undergoing valvular repair or replacement Perfusion, January 1, 2005; 20(1): 21 - 29. [Abstract] [PDF]

				S. V. Sheppard, R. V. Gibbs, and D. C. Smith Does leucocyte depletion during cardiopulmonary bypass improve oxygenation indices in patients with mild lung dysfunction? Br. J. Anaesth., December 1, 2004; 93(6): 789 - 792. [Abstract] [Full Text] [PDF]

				T. E. Karaiskos, G. M. Palatianos, C. D. Triantafillou, G. H. Kantidakis, G. M. Astras, E. G. Papadakis, and M. I. Vassili Clinical Effectiveness of Leukocyte Filtration During Cardiopulmonary Bypass in Patients with Chronic Obstructive Pulmonary Disease Ann. Thorac. Surg., October 1, 2004; 78(4): 1339 - 1344. [Abstract] [Full Text] [PDF]

				D. C. Whitaker, S. P. Newman, J. Stygall, C. Hope-Wynne, M. J.G. Harrison, and R. K. Walesby The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery Eur. J. Cardiothorac. Surg., February 1, 2004; 25(2): 267 - 274. [Abstract] [Full Text] [PDF]

				F. D. Rubens and T. Mesana Surface Modified Cardiopulmonary Bypass Circuits: Modifying the Inflammatory Response Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 301 - 306. [Abstract] [PDF]

				C. S.H. Ng, S. Wan, A. P.C. Yim, and A. A. Arifi Pulmonary Dysfunction After Cardiac Surgery* Chest, April 1, 2002; 121(4): 1269 - 1277. [Abstract] [Full Text] [PDF]

				A H Olivencia-Yurvati, W E Wallace, N Wallace, D Dimitrijevich, J K Knust, L Haas, and P B Raven Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation Perfusion, March 1, 2002; 17(2_suppl): 35 - 39. [Abstract] [PDF]

				G. A Ortolano, G. S Aldea, K. Lilly, P. O'Gara, J. D Alkon, F. Madera, T. Murad, C. P Altenbern, C. S Tritt, A. Capetandes, et al. A review of leukofiltration in cardiac surgery: the time course of reperfusion injury may facilitate study design of anti-inflammatory effects Perfusion, March 1, 2002; 17(2_suppl): 53 - 62. [Abstract] [PDF]

				D C Whitaker, J A Stygall, S P Newman, and M J. Harrison The use of leucocyte-depleting and conventional arterial line filters in cardiac surgery: a systematic review of clinical studies Perfusion, December 1, 2001; 16(6): 433 - 446. [Abstract] [PDF]

				G Matheis, M Scholz, A Simon, O. Dzemali, and A Moritz Leukocyte filtration in cardiac surgery: a review Perfusion, September 1, 2001; 16(5): 361 - 370. [Abstract] [PDF]

				S J Morris Leukocyte reduction in cardiovascular surgery Perfusion, September 1, 2001; 16(5): 371 - 380. [PDF]

				G Matheis, M Scholz, J Gerber, U Abdel-Rahman, G Wimmer-Greinecker, and A Moritz Leukocyte filtration in the early reperfusion phase on cardiopulmonary bypass reduces myocardial injury Perfusion, January 1, 2001; 16(1): 43 - 49. [Abstract] [PDF]

				J. P. Gott Leukodepletion and aprotinin improve clinical outcome after extracorporeal circulation Perfusion, January 1, 2001; 16(1_suppl): 5 - 9. [Abstract] [PDF]

				G Matheis, M Scholz, A Simon, D Henrich, G Wimmer-Greinecker, and A Moritz Timing of leukocyte filtration during cardiopulmonary bypass Perfusion, January 1, 2001; 16(1_suppl): 31 - 37. [Abstract] [PDF]

				S. M. Langley, P. J. Chai, S. S. Tsui, J. J. Jaggers, and R. M. Ungerleider THE EFFECTS OF A LEUKOCYTE-DEPLETING FILTER ON CEREBRAL AND RENAL RECOVERY AFTER DEEP HYPOTHERMIC CIRCULATORY ARREST J. Thorac. Cardiovasc. Surg., June 1, 2000; 119(6): 1262 - 1269. [Abstract] [Full Text] [PDF]

				H. E. Gilliland, M. A. Armstrong, and T. J. McMurray The Inflammatory Response to Pediatric Cardiac Surgery: Correlation of Granulocyte Adhesion Molecule Expression with Postoperative Oxygenation Anesth. Analg., November 1, 1999; 89(5): 1188 - 1188. [Full Text] [PDF]

				P G Browning, M Pullan, M Jackson, and A Rashid Leucocyte-depleted cardioplegia does not reduce reperfusion injury in hypothermic coronary artery bypass surgery Perfusion, September 1, 1999; 14(5): 371 - 377. [Abstract] [PDF]

				Y. J. Gu, A.J. de Vries, P. Vos, P. W. Boonstra, and W. van Oeveren Leukocyte depletion during cardiac operation: a new approach through the venous bypass circuit Ann. Thorac. Surg., March 1, 1999; 67(3): 604 - 609. [Abstract] [Full Text] [PDF]

				S. T Baksaas, H. I Flom-Halvorsen, E. Ovrum, V. Videm, T. E. Mollnes, F. Brosstad, and J. L Svennevig Leucocyte filtration during cardiopulmonary reperfusion in coronary artery bypass surgery Perfusion, March 1, 1999; 14(2): 107 - 117. [Abstract] [PDF]

				J. P. Gott, W. A. Cooper, F. E. Schmidt Jr, W. M. Brown III, C. E. Wright, J. D. Merlino, J. D. Fortenberry, W. S. Clark, and R. A. Guyton Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies Ann. Thorac. Surg., September 1, 1998; 66(3): 747 - 754. [Abstract] [Full Text] [PDF]

				A J Heggie, J S Corder, P R Crichton, J W Hesford, H Bingham, S Jeffries, and T L Hooper Clinical evaluation of the new Pall leucocyte-depleting blood cardioplegia filter (BC1) Perfusion, January 1, 1998; 13(1): 17 - 25. [Abstract] [PDF]

				Y. J. Gu, A. J. deVries, P. W. Boonstra, and W. van Oeveren LEUKOCYTE DEPLETION RESULTS IN IMPROVED LUNG FUNCTION AND REDUCED INFLAMMATORY RESPONSE AFTER CARDIAC SURGERY J. Thorac. Cardiovasc. Surg., August 1, 1996; 112(2): 494 - 500. [Abstract] [Full Text]