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Leukocyte depletion during cardiopulmonary bypass in routine adult cardiac surgery
J F Matthias Bechtel1, Simone Mühlenbein, Wolfgang Eichler
1Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
Insights
Intraoperative leukocyte depletion (LD) during cardiopulmonary bypass (CPB) in cardiac surgery did not show clear benefits. While faster extubation occurred, there were no significant differences in mortality or major complications.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Medical Technology
Background:
- Cardiopulmonary bypass (CPB) triggers an inflammatory response, partly due to leukocyte activation.
- The efficacy of intraoperative leukocyte depletion (LD) during CPB remains uncertain despite previous studies.
Purpose of the Study:
- To evaluate the impact of intraoperative leukocyte depletion (LD) using filters during routine adult cardiac surgery with CPB.
Main Methods:
- A retrospective study involving 532 adult patients undergoing cardiac surgery with CPB.
- Leukocyte filters were used continuously in arterial and cardioplegia lines for 2.5 months; control groups were patients operated immediately before and after.
Main Results:
- No significant differences in 30-day mortality, transfusion needs, or major morbidity between groups.
- Patients undergoing LD showed a trend towards lower preoperative leukocyte counts but no difference postoperatively.
- A significantly higher percentage of LD patients were extubated within 12 hours (69% vs. 60%).
Conclusions:
- The strategy of continuous intraoperative leukocyte depletion (LD) plus cardioplegia filtration during adult cardiac surgery with CPB did not demonstrate a clear clinical benefit.
- Further research may be needed to determine optimal LD strategies or patient populations that could benefit.
Objectives:
Cardiopulmonary bypass (CPB) elicits an inflammatory response which is potentially harmful and that is partly caused by activation of leukocytes. Despite promise from earlier studies, however, the value of intraoperative leukocyte-depletion (LD) remains equivocal. We studied the effect of LD during routine cardiac surgery.
Methods:
For a short period (2.5 months), all operations at our institution were performed with leukocyte filters (Pall, East Hills, NY, USA) in the arterial and cardioplegia lines of the CPB. Those patients operated immediately before and after this period served as controls.
Results:
In each group, 266 predominantly male (70%) patients were studied. A broad spectrum of operations including emergency surgery was evaluated, which was comparable between the groups (P=0.41). There were no significant differences regarding the preoperative data, but the preoperative leukocyte count tended to be lower in the leukodepletion-group (7961±2415 vs. 8444±2951, P=0.050). Despite this, no difference between the groups regarding the postoperative leukocyte count was observed. Significantly more LD-patients were extubated within 12 h postoperatively (69% vs. 60% in the control-group, P=0.029), but there were no significant differences regarding 30-day mortality (0.4% vs. 1.1%, P=0.37), transfusion requirements or major morbidity.
Conclusions:
In a retrospective study on adding LD filters to all cardiac operations with CPB in adults, we did not observe a clear benefit of intraoperative LD with the strategy used (continuous filtration plus filtration of cardioplegia).
