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DOI: 10.1055/s-2008-1037989
Effect of Leukocyte-depletion during routine adult cardiac surgery with CPB
Aims: Cardiopulmonary bypass [CPB] elicts an inflammatory response which is potentially harmful and that is partly caused by activation of leukocytes. Despite promise from earlier studies, however, the value of intraoperative leukocyte-depletion [LD] remains equivocal. We studied the effect of leukocyte-depletion during routine cardiac surgery.
Methods: For a short period (2.5 months), all operations at our institution were performed with leukocyte filters [PALL, East Hills, NY] in the arterial and cardioplegia lines of the CPB. Those patients operated immediately before and after this period served as controls.
Results: 532 patients were studied; 70% in both groups had CABG-surgery. There were no differences regarding preoperative data (Table 1).
|
|
control-group |
Leukocyte-filtration-group |
p |
|
male/female [n] |
185/81 |
185/81 |
1.00 |
|
age [years] |
66±11 |
70±11 |
0.25 |
|
height/weight |
171±9cm/81±15kg |
172±9cm/83±15 |
0.53/0.19 |
LD-patients had a significantly lower leukocyte-count immediately after surgery (p=0.047) and significantly less CK-MB-release during the first 24 hours (p=0.030), but not thereafter.
Significantly more LD-patients were extubated within 12 hours postoperatively (69% vs. 60%, p=0.029), but there were no significant differences regarding 30-day-mortality or major morbidity (Table 2).
|
|
control-group |
leukocyte-filtration-group |
p |
|
30-day mortality [n] |
3 (1.1%) |
1 (0.4%) |
0.37 |
|
overt myocardial infarction/low cardiac output/pneumonia/systemic inflammatory response syndrome/any infection [n] |
3 (1%)/20 (8%)/25 (5%)/5 (1%)/35 (13%) |
2 (1%)/13 (5%)/18 (3%)/4 (1%)/24 (9%) |
0.65/0.20/0.41/0.52/0.13 |
Conclusion: There is laboratory evidence of the effectivity of intraoperative leucocyte-depletion early after surgery. However, this did not translate into a measurable clinical advantage.