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Does leukofiltration reduce pulmonary infections in CABG patients? A prospective, randomized study with early results
Cliff P Connery1, Ioannis K Toumpoulis, Constantine E Anagnostopoulos
1St. Luke's-Roosevelt Hospital Center at Columbia University, New York, NY 10128, USA.
Insights
Using leukoreduced blood transfusions in coronary artery bypass grafting (CABG) patients significantly reduced pulmonary infections. This blood management strategy shows promise for improving patient outcomes after cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Infectious Disease Prevention
Background:
- Postoperative infections are a concern in patients undergoing coronary artery bypass grafting (CABG).
- Blood and/or blood product transfusion (BBPT) is common in CABG procedures.
- The efficacy of leukoreducing filters in preventing infections after BBPT in CABG patients has not been prospectively evaluated.
Purpose of the Study:
- To prospectively evaluate the impact of leukoreduced BBPT on postoperative infection rates in primary CABG patients.
- To compare infection incidence, mortality, and other clinical outcomes between patients receiving filtered and unfiltered BBPT.
Main Methods:
- A prospective randomized study involving 104 primary CABG patients.
- Patients received either leukoreduced BBPT using a Pall Purecell filter or standard BBPT (control group).
- Infection incidence was assessed, and mid-term survival data were collected and analyzed using Kaplan-Meier plots, stratified by EuroSCORE.
Main Results:
- A total of 69 transfused patients (38 filtered, 31 control) were analyzed after exclusions.
- The incidence of culture-proven infections was 13.2% in the filtered group versus 25.8% in the control group (P=0.224).
- Notably, no pulmonary tract infections occurred in the filtered group compared to 4 (12.9%) in controls (P=0.048).
Conclusions:
- Leukoreduced BBPT significantly reduced the incidence of pulmonary tract infections in CABG patients.
- While overall infection rates did not reach statistical significance, the reduction in pulmonary infections suggests a benefit.
- Further research may explore broader applications of leukoreduction in transfusion medicine for surgical patients.
Background:
We present the first prospective randomized study of primary coronary artery bypass grafting (CABG) patients who were analyzed for postoperative infections after undergoing blood and/or blood product transfusion (BBPT) with a Pall Purecell leukoreducing filter.
Methods And Results:
One hundred and four patients were enrolled between March 1998 and March 1999. Seventy-two of the patients received BBPT (average 5.6 units BBPT/filter patient and 5.6 units/control patient). Three patients who had CABG without extracorporeal circulation or mixed transfusions of filtered and unfiltered BBPT were excluded. The remaining 69 transfused patients (38 filtered, 31 control) were analyzed and the incidence of culture proven infections was recorded. Mid-term survival data were obtained from the National Death Index and Kaplan-Meier survival plots were constructed. All patients were stratified and matched according to the EuroSCORE.Thirty-day mortality was 2.6% and 3.2% for the filtered and control patients, respectively. There were 5 cases of culture proven infections in 38 filtered patients (13.2%) and 8 in 31 controls (25.8%), P = 0.224. No pulmonary tract infections were recorded in the filter group vs. 4 (12.9%) in controls, P = 0.048. Reduced length for mechanical ventilation (16.3 hours vs. 57.8, P = 0.103), length of stay (9.1 vs. 10.8 days, P = 0.685), as well as increased 50-month actuarial survival, (45.5 vs. 42.3 months, P=0.695) in filtered vs. control, respectively, were recorded.
Conclusions:
The use of leukoreduced BBPT reduced the incidence of pulmonary tract infections in patients undergoing CABG.