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J Thorac Cardiovasc Surg 1997;113:1116-1117
© 1997 Mosby, Inc.

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SINGLE LEUKOCYTE FILTER (PALL BC1B) FAILS IN MULTIDOSE COLD BLOOD CARDIOPLEGIA

Bad Nauheim, Germany

From the Division of Thoracic and Cardiovascular Surgery, Kerckoff Clinic, Max Planck Institute, Bad Nauheim, Germany.

Received for publication Nov. 18, 1996; accepted for publication Jan. 23, 1997. Address for reprints: Matthias Roth, MD, Department of Thoratcic and Cardiovascular Surgery, Kerckoff Clinic, Max Planck Institute, Benekestr. 2-8, 61231 Bad Nauheim, Germany.

Leukocyte depletion and its effect on reperfusion injury has been thoroughly investigated over the past several years. It has been shown to prevent myocardial edema, to decrease the incidence of ventricular arrhythmias, and to reduce free radical–mediated lung injury and cardiac reperfusion injury in animal models. Neutrophil granulocytes may cause myocardial stunning as a result of production of oxygen-derived free radicals, which may damage cell membranes, sarcoplasmic reticulum, and different enzymes. Furthermore, granulocytes can plug capillaries during ischemia; after their degranulation, cell membranes may be damaged by different cell enzymes. Several reports describe leukocyte depletion in human beings. However, most results are not conclusive, especially with regard to filter efficiency. ^1-3 This study was undertaken to test the efficiency of the Pall BC1B leukocyte filter (Pall Biomedical Products Corp., East Hills, N.Y.) during multidose cold blood cardioplegia.

In a future study we intend to apply leukocyte-depleted blood during blood cardioplegic perfusion and during the first 5 minutes of reperfusion in selected patients with reduced left ventricular function (ejection fraction < 35%) using a double-blind study protocol. Before doing this study, we wanted to test the efficiency of the Pall BC1B leukocyte filter for blood cardioplegia in 16 patients.

Methods.

Intermittent cold blood cardioplegic solution was used in all patients. Before aortic declamping the "hot shot" was infused during 4 minutes (250 ml · min^–1). All patients received a combination of antegrade (50%) and retrograde (50%) cardioplegic infusion. A single or a double leukocyte filter BC1B for blood cardioplegia (Pall Biomedical) was placed in the cardioplegia line before blood was mixed with cardioplegic solution.

Blood samples for blood cell counts were collected proximal and distal to the leukocyte filter. Blood cell counts were immediately determined on samples containing ethylenediaminetetraacetic acid with the use of a counter (Sysmex K 1000, Sysmex Corporation of America, Long Grove, Ill.) and differential cell counting in Nageotte chambers.

The results are presented as the mean ± standard error of the mean. Statistical analysis was performed by means of the Mann-Whitney U test for difference in medians, after an analysis of variance. A p value < 0.01 was considered to be statistically significant.

Results.

Filtration rates of blood cells are depicted in Table I. After the second period of cardioplegia, the filtration rate of leukocytes in patients with only one filter was significantly lower than that of patients with two filters. Similar results were obtained from neutrophil and lymphocyte counts. Platelets were barely filtered in either group. However, the filtration rate for platelets was higher in the double filter group.

Ishihara and coworkers ³ demonstrated that elimination of neutrophils by a filter down-regulated neutrophil elastase and lipid peroxidation, resulting in significantly lower values of creatine kinase MB. They summarized that leukocyte removal filters may decrease the myocardial damage caused by neutrophils during cold blood cardioplegia in cardiac operations. Sawa and associates ¹ found that use of terminal leukocyte-depleted blood cardioplegia reduced the release of oxygen-derived free radicals and the amount of catecholamine support. However, Mihaljevic and colleagues ² could not demonstrate a favorable effect after use of a leukocyte filter.

Heggie and coworkers ⁴ reported a leukocyte filtration rate of 75% for up to 5.3 liters of whole blood when a Pall BC1B filter was used; the filtration rates for platelets and erythrocytes were 15% and 2.5%, respectively. In our study, the leukocyte filtration rates when a single Pall BC1B filter was used were 97.6% and 86.5% during the first two cardioplegic perfusions. However, during the following perfusions, the filtration rate in the single filter group was significantly lower than in the double filter group. Thus we could demonstrate that the filtration rate of one single filter is insufficient after just two perfusions of cardioplegic solution. Inasmuch as leukocyte depletion increases left ventricular recovery, especially in the initial reperfusion period, a sufficient leukocyte filtration rate would be essential during the terminal perfusion with blood cardioplegia.

We conclude that leukocyte filtration with a single Pall BC1B filter for blood cardioplegia is merely effective up to 800 ml of whole blood. When additional perfusions are necessary, a second filter is required to attempt effective leukocyte filtration.

References

1. Sawa Y, Matsuda H, Shimazaki Y, Kaneka M, Nishimura M, Amemiya A, et al. Evaluation of leukocyte-depleted terminal blood cardioplegic solution in patients undergoing elective and emergency coronary artery bypass grafting. J Thorac Cardiovasc Surg 1994;108:1125-31.[Abstract/Free Full Text]
   
2. Mihaljevic T, Tönz M, von Segesser LK, Pasic M, Grob P, Fehr J, et al. The influence of leukocyte filtration during cardiopulmonary bypass on postoperative lung function. J Thorac Cardiovasc Surg 1995;109:1138-45.
   
3. Ichihara T, Yasuura K, Maseki T, Matsuura A, Miyahara K, Ito T, et al. The effects of using a leukocyte removal filter during cold blood cardioplegia. Jpn J Surg 1994;24:966-72.
   
4. Heggie AJ, Corder JC, Crichton PR, Hesord JW, Bingham H, Jeffries S, et al. Clinical evaluation of the new Pall leukocyte depleting blood cardioplegia filter (BC1B). Presented at the Twentieth Anniversary Congress on Perfusion of the Society of Perfusionists of Great Britain. Dublin, Ireland. September 30-October 1, 1994.
   
5. Wilson IC, Gardner TJ, DiNatale JM, Gillinov AM, Curtis WE, Cameron DE. Temporary leukocyte depletion reduces ventricular dysfunction during prolonged postischemic reperfusion. J Thorac Cardiovasc Surg 1993;106:805-10.[Abstract]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Matthias Roth Erwin P. Bauer Oliver Reuthebuch Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Roth, M. Articles by Klövekorn, W. P. Search for Related Content PubMed PubMed Citation Articles by Roth, M. Articles by Klövekorn, W. P.