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J Thorac Cardiovasc Surg 1996;111:45-54
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

LEUKOCYTE AND PLATELET DEPLETION WITH A BLOOD CELL SEPARATOR: EFFECTS ON LUNG INJURY AFTER CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

Fukui, Japan

From the Second Department of Surgery, Fukui Medical School, Fukui, Japan.

Received for publication April 28, 1994. Accepted for publication April 6, 1995. Address for reprints: Koichi Morioka, MD, 200 Mishima, Tenri, Nara, 632 Japan.

Abstract

This study was undertaken to assess the effects of leukocyte and platelet depletion on postoperative lung injury in 42 patients who underwent heart operations. Blood was serially sampled before, during, and after cardiopulmonary bypass, and leukocyte count, platelet count, and thromboxane B₂6-keto-PGF₁, leukocyte elastase, thrombin–antithrombin III complex, and D-dimer levels were determined. Postoperative respiratory function was assessed based on analyses of oxygenation and carbon dioxide elimination. Leukocyte and platelet depletion was performed in 21 patients (experimental group) but not in another (control group). In the experimental group, leukocytes and platelets were removed continuously by means of the blood cell separator CS-3000, beginning immediately after the start of the operation and ending 1 hour after the release of aortic occlusion. Leukocyte elastase, thromboxane B₂, ratio of thromboxane B₂to 6-keto-PGF₁, thrombin–antithrombin III complex, and D-dimer were significantly lower in the experimental group than in the control group. Of the various indexes of oxygenation, arterial oxygen tension was significantly higher in the experimental group and the alveolar-arterial oxygen pressure difference and respiratory index were significantly lower in the experimental group. The positive end-expiratory pressure needed to achieve an appropriate arterial oxygen tension was significantly lower in the experimental group. The elimination of carbon dioxide was lower in the experimental group. Depletion of leukocytes and platelets reduced respiratory dysfunction after heart operations with cardiopulmonary bypass. It was particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of cardiopulmonary bypass was required. (J THORACCARDIOVASCSURG1996;111:45-54)

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