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Temporary leukocyte depletion reduces ventricular dysfunction during prolonged postischemic reperfusion

I C Wilson1, T J Gardner, J M DiNatale

  • 1Department of Cardiac Surgery, Johns Hopkins Medical Institution, Baltimore, Md. 21205.

The Journal of Thoracic and Cardiovascular Surgery
|November 1, 1993
PubMed
Summary

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Leukocyte depletion in neonatal cardiac surgery improves heart function after bypass. Even with rapid white blood cell return, depleted animals showed better ventricular performance and reduced tissue damage.

Area of Science:

  • Cardiovascular Surgery
  • Neonatal Cardiology
  • Immunology

Background:

  • Leukocyte depletion is known to improve early postischemic ventricular function in neonatal models.
  • The rate of leukocyte reaccumulation after cardiopulmonary bypass and its impact on myocardial function remain unclear.

Purpose of the Study:

  • To investigate the effect of leukocyte depletion on myocardial performance during the initial 6 hours after cardiopulmonary bypass in a porcine model of neonatal cardiac surgery.

Main Methods:

  • Utilized an in situ, in vivo porcine model of neonatal cardiac surgery (3- to 5-day-old piglets).
  • Employed mechanical leukocyte depletion using Pall RC100 filters in the cardiopulmonary bypass circuit.
  • Assessed left ventricular performance using sonomicrometry crystals and an intraventricular micromanometer catheter following 90 minutes of hypothermic ischemia.

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Main Results:

  • Leukocyte filtration significantly reduced granulocyte counts during initial reperfusion.
  • Despite rapid granulocyte reaccumulation (68% of control by 6 hours), leukocyte-depleted animals showed significantly better preservation of left ventricular performance, systolic function, and compliance.
  • Control animals exhibited increased left ventricular water content and myeloperoxidase activity compared to leukocyte-depleted animals.

Conclusions:

  • Leukocyte depletion during initial reperfusion leads to sustained improvement in postischemic left ventricular function in neonatal cardiac surgery.
  • This functional improvement occurs despite the rapid return of circulating granulocytes.
  • The findings suggest a crucial role for leukocytes in post-bypass myocardial dysfunction in neonates.