Depletion of activated neutrophils by a filter during cardiac valve surgery

Abstract

Depletion of activated neutrophils by a filter during cardiac valve surgeryPurpose: To determine whether inclusion of a neutrophil-speciflc filter into the extracorporeal circuit during open heart valve surgery alters postoperative outcomes.Methods: Convenience sampling of 24 patients undergoing elective open heart valve surgery between July 1993 and June 1994. Patients were randomized to a neutrophil-specific filter (n= I I) orto a standard blood filter (n= 13) during cardiopulmonary bypass.Results: Neutrophil-specific filter diminished (P <0,02) the expression of CD 18, a neutrophil surface adhesion molecule, at I (84,5 + 4.2 vs 94,8 _+ 3.8%), 4 (80.0 -4.2 vs 95. I ___ 3.9%) and 24 hr (75.2 + 4.2 vs 98,2 _+ 3.9%) post-operatively compared with standard filter. Total white blood cell count, neutrophil count, and proinflammatory cytokines (IL-6, IL-8) were similar between groups at all times. Measured outcomes including: F'aO 2, cardiac index, ejection fraction, haemodynamic variables, use of inotropes, spirometry (FEV~. FVC), and hospitalization duration were similar between groups.Conclusions: Inclusion of the neutrophil filter during open heart valve surgery selectively depletes activated neutrophils. There were no other detectable differences between the two groups and the use of a neutrophilspecific filter in routine clinical practice for patients undergoing open heart valve surgery is not supported.Objectif : D&erminer si I'ajout au circuit extracorporel d'un filtre sp&ifique aux neutrophiles pendant une chirurgie valvulaire modifiait les r&ultats de I'intervention M&hodes : Un &hantillonnage de 24 patients subissant une intervention valvulaire ~ coeur ouvert entre juillet 1993 et juin 1994. Les patients ont ~t~ r~partis al~atoirement ~ un circuit extracorporel incluant un filtre sp&i-fique aux neutrophites (n = I I) ou un filtre standard (n= 13).R&ultats : Le filtre sp&ifique aux neutrophiles a diminu~ I'expression de CDI 8, une mol&ule adh&ive de surface, une heure (84,5 + 4,2 vs 98,8 _ 3,8%), quatre heures (80 +-4,2 vs 95,1 +_ 3,9%) et 24 heures (75,2 +_ 4,2 vs 98,2 -+ 3,9%) apr~s I'op&ation comparativement au flltre standard. Le d&ompte total des globules blancs, des neutrophiles et des cytokines pro-inflammatoires (IL-6, IL8) &aient ~ tous les moments identiques entre les groupes. Les mesures de r&ultats incluant la PaO 2, I'index cardiaque, la fraction d'~jection, les donn~es h~modynamiques, I'utilisation d'inotropes, la spirom~trie (VEMS, CVF) et la dur~e du s~jour hospitalier ~taient identiques entre les groupes, Conclusion : !Lajout d'un filtre sp&ifique aux neutrophiles pendant la chirurgie ~ coeur ouvert ~puise s~lec-tivement les neutrophiles activ~s. Aucune autre diff&ence n'est discernable entre les groupes, l'utilisation courante de filtres sp&ifiques aux neutrophiles en clinique chez des patients soumis ~ une chirurgie valvulaire coeur ouvert n'est pas justifi6e.

The effects of various leukocyte filtration strategies in cardiac surgery

“…IL-1, IL-6, IL-8 and TNF) during or after cardiac surgery [22,23,39,46,50,55]. The only study to show a significant effect utilized a venous line leukodepleting filter [10] and observed a significant decrease in IL-8 compared to controls.…”

“…In a study that included only three patients (one filtered and two controls), Thurlow et al observed a gradient in the expression of CD11a and CD45RO across the filter not seen in the two control patients and also claimed that the filter selectively removed activated leukocytes [40]. The effect of filtration on CD-11b expression appears to be variable, with no difference [27,39], downregulation [51] and up-regulation of CD-11b [48] all having been reported. In a clinical study on patients undergoing CABG surgery by Chen et al [52], L-selectin, P-selectin, ICAM-1 and PECAM-1 were all significantly reduced by leukofiltration.…”

“…Only eight studies within this section of the review did not record pre-and post-operative WCC. Of the 26 that did, 15 found no significant difference between filtered patients and controls at any point in the patients admission [9,22,23,27,[39][40][41][42][43][44][45][46][47][48][49][50]. The remaining 11 papers found reduced WCCs in the filtered group mainly during CPB, although these differences tended to disappear after CPB [10,26,35,[51][52][53].…”

“…found a decrease in CD18 expression on neutrophils in the filtered group, and suggested that the filter could selectively remove activated leukocytes [39]. In a study that included only three patients (one filtered and two controls), Thurlow et al observed a gradient in the expression of CD11a and CD45RO across the filter not seen in the two control patients and also claimed that the filter selectively removed activated leukocytes [40].…”

The effect of leucodepletion on leucocyte activation, pulmonary inflammation and respiratory index in surgery for coronary revascularisation: a prospective randomised study☆

“…In the clinical field, one study reported reduced expression of the CD18 surface adhesion molecule after use of arterial line leucocyte filtration in patients undergoing heart valve operations [12]. A more recent report described a significant reduction in the expression of the adhesion molecules CD11b and L-selectin with continuous arterial line leucocyte depletion in CABG surgery [13].…”