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J Thorac Cardiovasc Surg 2000;120:642-650
© 2000 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Departments of Thoracic and Cardiovascular Surgerya and Anesthesiology,b Kerckhoff-Clinic Foundation, Bad Nauheim, and the Department of Cardiology,c Heart Center Baden, Lahr, Germany.
Address for reprints: Matthias Roth, MD, Department of Thoracic and Cardiovascular Surgery, Kerckhoff-Clinic Foundation, Benekestr 2-8, 61231 Bad Nauheim, Germany (E-mail: Matthias.Roth{at}kerckhoff.med.uni-giessen.de).
Background: The propensity for leukocytes to cause reperfusion injury in patients undergoing heart surgery is widely accepted. Reperfusion injury may result in myocardial damage and unfavorable operative outcome, especially in patients with severely reduced ejection fractions. This study was performed to evaluate the impact of leukocyte filtration on the postoperative course of patients undergoing coronary bypass surgery.
Methods: Thirty-two patients with coronary artery disease and left ventricular ejection fraction less than 35% were included in this double-blind, randomized study. Two serial leukocyte removal filters (Pall BC1B filter [Pall Biomedical, Portsmouth, England], group F, 15 patients) or two dummy filters (group C, 17 patients) were connected to the blood cardioplegia line. Leukocyte count, hemodynamic measurement, and transesophageal echocardiography were performed before and after cardiopulmonary bypass. Cardiac-specific enzymes were analyzed from arterial blood during the first 72 hours and from coronary sinus blood 30 and 60 minutes after aortic unclamping.
Results: Patient characteristics were similar in the two groups (ejection fraction 20.9% ± 4.3% in group C and 21.1% ± 4.8% in group F; P = .773). No early death or perioperative myocardial infarction occurred. Leukocyte count, hemodynamic parameters, cardiac troponin T, cardiac troponin I, and creatine kinase MB mass levels in arterial blood were similar in the two groups. Group F showed lower release of cardiac troponin T from the coronary sinus 30 minutes after unclamping of the aorta (group F, 0.263 ± 0.12 ng/mL; group C, 0.6 ± 0.32 ng/mL; P = .005). Lower doses of dopamine were necessary after cardiopulmonary bypass (group F, 0.36 ± 0.11 mg · kg–1 · min–1; group C, 0.49 ± 0.14 mg · kg–1 · min–1; P = .003). A moderate increase in ejection fraction was observed at 30 minutes in both groups (group F, 30.3% ± 6.2%; group C, 28.0% ± 6.3%; P = .239) and a significant increase at 60 minutes in group F (group F, 32.5% ± 6.0%; group C, 27.4% ± 7.5%; P = .012).
Conclusions: These results indicate that serial leukocyte filters connected to the blood cardioplegia line decrease myocardial cell injury and may therefore help to improve outcome of patients with severely depressed ejection fractions undergoing coronary artery bypass grafting.
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