Abstract 222: Combination of Blood Cardioplegic and Strategic Reperfusion Period Leucodepletion During Cardiopulmonary Bypass Preserves the Cardiac and Pulmonary Function: A Prospective Randomized Controlled Study
Objectives: Leucocytes activation during cardiopulmonary bypass (CPB) contributes to postoperative organ dysfunction. We compared the outcomes of various leucodepletion strategies in patients undergoing coronary artery bypass grafting (CABG).
Methods: One hundred-twenty low-risk patients undergoing first time CABG were prospectively randomized to six groups: 1 non-leucodepletion arterial filtration; 2 continuous arterial leucodepletion; 3 reperfusion period leucodepletion; 4 leucodepletion of blood cardioplegia; 5 combination of continuous arterial and blood cardioplegic leucodepletion; 6 combination of blood cardioplegic and reperfusion period leucodepletion. Blood samples were taken 5 min before CPB, 5 and 30 min on CPB, 5, 60 min after aortic X-clamp removal and 6 h post-CPB. Activated leucocytes were identified with Nitroblue Tetrazolium staining. Exhaled nitro oxide (NO) was measured pre- and post-CPB using real-time chemiluminescense analyzer. Respiratory index (alveolar-arterial oxygenation index, AaOI) was calculated 5 min before CPB and 5 min on CPB, 1, 2, 4, 8 and 18 h post-CPB.
Results: Activated white cell counts were similar before CPB in all groups, but reduced significantly 5, 60 min following aortic X-clamp removal, and 6 h post-CPB in groups 2, 3, 5 and 6, compared with group 1 (ANOVA p=0.02). Post-CPB, NO increased in all groups (p<0.05) except in Group 6 (3.17±0.64 vs. 3.63±0.79 ppb/s, p=0.22). Group 6 exhibited a lower AaOI than group 1 over all time points post-CPB (ANOVA, p=0.02). Postoperatively, there was a significant reduction in inotropic requirement, ventilation time and atrial fibrillation in group 6 (p=0.045, 0.04 and 0.043, respectively). There was no difference in chest drain output, length of ICU and hospital stay among all groups.
Conclusions: Combination of blood cardioplegic and reperfusion period leucodepletion appeared to be most effective in attenuating activated leucocytes during CPB, which was associated with better preservation of cardiac and pulmonary function compared with other leucodepletion strategies.
- © 2012 by American Heart Association, Inc.