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J Thorac Cardiovasc Surg 2000;120:1131-1140
© 2000 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Leukocyte filtration improves brain protection after a prolonged period of hypothermic circulatory arrest: A study in a chronic porcine model

From the Departments of Surgery^a and Anaesthesiology,^b the Laboratory of Clinical Neurophysiology,^c Oulu University Hospital, and the Department of Forensic Medicine,^d University of Oulu, Oulu, Finland.

These studies were supported by grants from Oulu University Hospital, the Finnish Foundation for Cardiovascular Research, and the Sigrid Juselius Foundation.

Address for reprints: Professor Tatu Juvonen, MD, PhD, Department of Surgery, Oulu University Hospital, FIN 90220 Oulu, Finland (E-mail: tatu.juvonen{at}oulu.fi).

Background: Ischemic cerebral injury follows a well-attested sequence of events, including 3 phases: depolarization, biochemical cascade, and reperfusion injury. Leukocyte infiltration and cytokine-mediated inflammatory reaction are known to play a pivotal role in the reperfusion phase. These events exacerbate the brain injury by impairing the normal microvascular perfusion and through the release of cytotoxic enzymes. The aim of the present study was to determine whether a leukocyte-depleting filter (LeukoGuard LG6, Pall Biomedical, Portsmouth, United Kingdom) could improve the cerebral outcome after hypothermic circulatory arrest.
Methods: Twenty pigs (23-30 kg) were randomly assigned to undergo cardiopulmonary bypass with or without a leukocyte-depleting filter before and after a 75-minute period of hypothermic circulatory arrest at 20°C. Electroencephalographic recovery, S-100ß protein levels, and cytokine levels (interleukin 1ß, interleukin 8, and tumor necrosis factor ) were recorded up to the first postoperative day. Postoperatively, all animals were evaluated daily until death or until electively being put to death on day 7 by using a quantitative behavioral score. A postmortem histologic analysis of the brain was carried out on all animals.
Results: The rate of mortality was 2 of 10 in the leukocyte-depletion group and 5 of 10 in control animals. The risk for early death in control animals was 2.5 (95% confidence interval, 0.63-10.0) times higher than that of the leukocyte-depleted animals. The median behavioral score at day 7 was higher in the leukocyte-depletion group (8.5 vs 3.5; P = .04). The median of total histopathologic score was 8.5 in the leukocyte-depletion group and 15.5 in the control group (P = .005).
Conclusion: A leukocyte-depleting filter improves brain protection after a prolonged period of hypothermic circulatory arrest.

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