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J Thorac Cardiovasc Surg 1994;108:1125-1131
© 1994 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
Osaka, Japan
From the First Department of Surgery, Osaka University Medical School, Osaka, Japan.
Received for publication Dec. 17, 1993. Accepted for publication May 31, 1994. Address for reprints: Hikaru Matsuda, MD, Professor, First Department of Surgery, Osaka University Medical School, 2-2, Yamada-oka, Suita, Osaka 565, Japan.
Abstract
Leukocyte depletion at reperfusion may have a role in myocardial protection when combined with terminal cardioplegia. We applied this method in a selected group of 68 patients with coronary artery bypass grafting either for elective surgical procedures (n= 38) or emergency surgical procedures with the use of a preoperative intraaortic balloon pump (n= 30) because of developing acute myocardial infarction. Basic cold potassium crystalloid cardioplegic solution was used. During delivery of leukocyte-depleted terminal cardioplegic solution, warm arterial blood delivered from cardiopulmonary bypass was passed through a leukocyte removal filter, mixed with potassium crystalloid cardioplegic solution, and administered to the aortic root for the first 10 minutes of reperfusion. Patients were randomized into three groups for reperfusion: whole blood, terminal cardioplegic solution, and leukocyte-depleted terminal cardioplegic solution reperfusion groups. In elective coronary artery bypass grafting, no significant difference was found in the clinical data. However, in emergency coronary artery bypass grafting, the leukocyte-depleted terminal cardioplegic solution group (n= 10) showed significantly lower peak creatine kinase MB levels (leukocyte-depleted terminal cardioplegic solution versus terminal cardioplegic solution versus whole blood: 27 ± 11, 56 ± 13, 74 ± 18, respectively; p< 0.05) and maximum dopamine doses required at the weaning of cardiopulmonary bypass (6.3 ± 1.1 versus 11.2 ± 3.3 versus 9.2 ± 2.2; p< 0.05) than did the terminal cardioplegic solution (n= 10) and whole blood groups (n= 10). Moreover, the leukocyte-depleted terminal cardioplegic solution group showed significantly lower difference of malondialdehyde between arterial and coronary sinus blood (0.15 ± 0.09 versus 0.36 ± 0.06 versus 0.66 ± 0.12 nmol/ml, p< 0.05) than did the terminal cardioplegic solution or whole blood groups. These results showed that leukocyte-depleted terminal blood cardioplegic solution may have a role in attenuating reperfusion injury in patients with critical conditions such as preoperative myocardial ischemic injury. (J THORACCARDIOVASCSURG1994;108:1125-31)
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