Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?

摘要

OBJECTIVE: The powerful precept of preoperative risk assessment has been applied to compare the efficacy of leukofiltration techniques for high-risk cohorts with the documentation of broad indicators of systemic inflammation. METHODS: Forty high risk patients were prospectively assigned to four perfusion protocols; the first group (n=10): Polyethyleneoxide (PEO) based heparin bonded extracorporeal circuits (ECC) + Continuous Leukocyte filtration; the second group (n=10): uncoated ECC + leukofiltration; the third group (n=10): PEO based heparin bonded ECC without leukofiltration; and control (n=10). Blood samples were obtained at the following intervals: Baseline (T1), on cardiopulmonary bypass (CPB) (T2), Cross clamp (T3), off CPB (T4), Intensive care unit-24 h (ICU24) (T5), ICU48 (T6). RESULTS: Tumor Necrosis Factor-alpha levels were significantly lower in Group 1 at T3, T4 (p<0.05) vs. control. Procalcitonin levels were significantly lower in Group 1 at T5, T6 (p<0.05) vs. control. Creatinine kinase-MB levels in coronary sinus blood demonstrated well preserved myocardium in filtered+coated (Group 1) and coated groups (Group 3) (p<0.05). Matrix metallopeptidase- 9 and D-Dimer levels in filtered+coated group were significantly lower at T5 and T6 vs. control (p<0.05). CONCLUSION: Leukocyte filtration on coated surfaces alleviated systemic inflammatory response with a better clinical outcome in high risk patients.