Leukocyte reduction in cardiovascular surgery

Sj, Morris

doi:10.1177/026765910101600507

Cited by 9 publications

(7 citation statements)

References 78 publications

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“…Clinical appreciation of the invocation of the inflammatory response following cardiac surgery in neonates has resulted in a number of interventions directed at its reduction. For example, modification of pump circuit surfaces, ultrafiltration strategies, leukocyte trapping filters, and glucocorticoid administration have all been described to reduce or eliminate clinical or biochemical features of the inflammatory response following CPB (35–37). A survey of 36 centers that perform pediatric CPB demonstrated that none of these interventions has achieved a level of standard practice in the pediatric or neonatal population (35).…”

Section: Discussionmentioning

confidence: 99%

Cardiac Function and Circulating Cytokines Following Endotoxin Exposure in Neonatal Mice

et al. 2010

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Complications following cardiac surgery in neonates can occur due to activation of the inflammatory system. This study used lipopolysaccharide (LPS) endotoxin exposure to cause cytokine activation in neonatal mice and examine left ventricular (LV) function as well as the effects of antioxidant treatment on cytokine levels. Neonatal mice (6 day old) were injected with either 25 mg/kg LPS (n=13) or phosphate buffered saline (PBS, n=14) and LV function (echocardiography) was measured at 4 hours. Plasma levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-4, IL-6, and IL-10 were measured at 30 min, 1, 2, and 4 hours after injection (n=5 mice per group). Effects of pretreatment with N-acetylcysteine (NAC, 50 mg/kg) on cytokine levels were examined at 2 and 4 hours following PBS or LPS (n=5 mice per group). Four hours after LPS heart rate was increased (434±14 vs. 405±14 bpm, p<0.05). LV end-diastolic dimension and ejection time were reduced with LPS (both p<0.05). LPS exposure increased plasma TNF-α, IL-6, and IL-10 levels. NAC pretreatment attenuated the increases in TNF-α and IL-6 levels, but augmented IL-10 levels at 2 hours post-LPS. LPS exposure altered cardiac performance and activated cytokines in neonatal mice, which may be ameliorated using antioxidants.

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Section: Discussionmentioning

confidence: 99%

Cardiac Function and Circulating Cytokines Following Endotoxin Exposure in Neonatal Mice

et al. 2010

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“…Whilst there are previous review articles pertaining to the use of leukocyte filters [18,[30][31][32][33][34] they are either not systematic, or focus on just one strategy or site for the filter. Furthermore, they are dated.…”

Section: Aim and Scope Of Reviewmentioning

confidence: 99%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

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It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.

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“…22 Neutrophils are also activated during reperfusion of the myocardium and lungs because of oxidative stress and activated endothelium. 22,23 In addition, cell washing may further activate neutrophils. 23 Retransfusion of processed autologous blood may, therefore, further aggravate the leukocyte-mediated systemic inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

“…22,23 In addition, cell washing may further activate neutrophils. 23 Retransfusion of processed autologous blood may, therefore, further aggravate the leukocyte-mediated systemic inflammatory response. To eliminate this white blood cell content, a leukocyte-depletion filter can be used prior to retransfusion.…”

Section: Introductionmentioning

confidence: 99%

Leukocyte removal efficiency of cell-washed and unwashed whole blood: an in vitro study

et al. 2005

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Leukocyte filtration of the cardiopulmonary bypass (CPB) perfusate after cardiac surgery has evolved as an important technique to prevent effector functions mediated by activated leukocytes. However, little is known about the filtration efficiency. Therefore, an in vitro study was conducted to define the leukocyte removal rate of a transfusion leukocyte-depletion filter, using cell-washed and unwashed whole porcine blood. In addition, the influence of different cell-washing protocols on the elimination rate of blood cells (leukocytes and platelets) was investigated. Fresh, diluted, pooled, heparinized, porcine blood was processed using either a high-flow (HF, n = 5) or quality-wash (QW, n = 5) protocol on a continuous auto-transfusion system, or was left unprocessed (control n=5). Thereafter, all samples were filtered using a transfusion leukocyte-depletion filter. Blood samples for measurement of hematocrit, white blood cell count, including leukocyte differentiation and platelet count, were taken before and after filtration. To compare the experimental groups, the removal rate was presented as the fraction of leukocytes or platelets removed per plasma volume. Cell washing significantly altered the fraction of leukocytes removed per plasma volume when compared to unprocessed blood (2.07 and 2.36 in the HF and QW groups, respectively, versus 1.34 in the control group, p = 0.008 for both). No statistically significant difference in leukocyte removal rate was observed between the different cell-washing protocols. The leukocyte differential count showed that, during all experiments, the neutrophils were removed most efficiently (99.7%). Overall, significantly more platelets were depleted after cell washing compared to the control group (1.47 and 1.60 in the HF and QW groups, respectively, versus 1.12 in the control group, p =0.008 and 0.032, respectively). Furthermore, the amount of blood that could be filtered using a single pass technique did not significantly differ between the experimental groups. However, a larger variation in the total amount of filtered blood was observed in the unprocessed group (570+/-398 mL) compared to the cell-washed groups (360+/-42 and 430+/-97 mL in the HF and QW groups, respectively). In conclusion, blood processing with an auto-transfusion system significantly enhances the leukocyte and platelet removal efficiency of the transfusion leukocyte-depletion filter that was studied. In particular, neutrophils were efficiently removed.

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Leukocyte reduction in cardiovascular surgery

Cited by 9 publications

References 78 publications

Cardiac Function and Circulating Cytokines Following Endotoxin Exposure in Neonatal Mice

Cardiac Function and Circulating Cytokines Following Endotoxin Exposure in Neonatal Mice

The effects of various leukocyte filtration strategies in cardiac surgery

Leukocyte removal efficiency of cell-washed and unwashed whole blood: an in vitro study

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