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document
The effect of leukocyte reduction filters on inflammatory mediator release during coronary artery bypass grafting . BACKGROUND Extracorporeal circulation used during coronary artery bypass grafting triggers systemic inflammatory response with neutrophil activation which adversely affects ischaemic/reperfused myocardium . One method of myocardial protection during cardiac surgery is the use of blood cardioplegia . Its protective effect is related to cardiac cooling and metabolism reduction , oxygen supply from erythrocytes , and reactive oxygen species scavenging . However , blood cardioplegia is also associated with myocardial damage induced by undesirable morphotic blood elements . AIM To evaluate the effect of the use of leukocyte reduction filters on the activity of polymorphonuclear neutrophils ( PMN ) in patients undergoing surgical myocardial revascularisation . PMN activity was evaluated based on measurements of plasma activity of granulocyte enzymes , lysozyme and beta-glucuronidase . METHODS We studied 40 patients who underwent myocardial revascularisation using extracorporeal circulation . Patients were randomly assigned to two equal groups : in Group I , blood cardioplegia was administered using leukocyte reduction filters , and in Group II , leukocyte reduction filters were not used for blood cardioplegia . Measurements were performed in plasma of arterial and coronary sinus blood samples collected before aortic clamping , immediately after unclamping , and after 25 min of reperfusion . In addition , blood cardioplegic solution samples were collected in Group I from the lines proximal and distal to the filter during first and last administration . Plasma levels of lysozyme and beta-glucuronidase were determined using previously described methods . RESULTS We found a significant decrease in PMN count in filtered blood cardioplegic solution during its first administration ( 0.27 ± 0.07 G/L ) compared to samples collected before filter passage ( 1.73 ± 0.049 G/L ) . Also during last administration , PMN count in filtered blood cardioplegic solution was decreased compared to samples collected before filter passage ( 0.66 ± 0.35 G/L vs. 3.64 ± 1.14 G/L , respectively ) . Significantly lower ( p < 0.02 ) plasma beta-glucuronidase levels were found in arterial blood samples in Group I compared to Group II ( 5.59 ± 1.63 μg/mL immediately after aortic unclamping and 6.59 ± 1.98 μg/mL after 25 min of reperfusion in Group I vs. 10.19 ± 2.66 and 12.83 ± 1.88 μg/mL , respectively , in Group II ) . Beta-glucuronidase levels in coronary sinus blood samples collected after aortic unclamping and at the end of reperfusion were significantly higher in Group II compared to Group I ( p < 0.04 ) . In Group I , plasma lysozyme levels in arterial and venous blood samples did not show significant changes during the surgery . In contrast , plasma lysozyme level in coronary sinus blood samples at the end of reperfusion in Group II was significantly higher compared to that in pre-clamping samples ( p < 0.014 ) . CONCLUSIONS With the use of leukocyte reduction filters , we found significantly lower beta-glucuronidase levels in arterial and coronary sinus blood samples . These findings seem to confirm reduced PMN activation and/or reduced myocardial infiltration by activated PMN . Plasma levels of lysozyme , a characteristic product of PMN degranulation , did not show significant differences between the study groups .
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Intervention_Physical
leukocyte reduction filters
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Intervention_Physical
leukocyte reduction filters
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Intervention_Physical
extracorporeal circulation
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Intervention_Physical
leukocyte reduction filters were not used for blood cardioplegia
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Outcome_Physical
Plasma levels of lysozyme and beta-glucuronidase
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Outcome_Physical
PMN count
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Outcome_Physical
blood cardioplegic solution
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Participant_Condition
surgical myocardial revascularisation
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Participant_Sample-size
40 patients