Prevention of the hypoxic reoxygenation injury with the use of a leukocyte-depleting filter

Abstract

(1) This study demonstrates that a major component of the injury that occurs when the hypoxic heart is abruptly reoxygenated is caused by oxygen radicals produced by white blood cells; (2) this injury can be prevented by a leukocyte-depleting filter; and (3) avoidance of this injury improves postbypass myocardial and pulmonary function. These data suggest that leukocyte depletion should be used routinely in all children undergoing operations for cyanotic heart disease or extracorporeal membrane oxygenation.

Myocardial Protection in Neonates and Infants: What have we Learnt? Where do we Go?

“…In the immature particularly cyanotic heart there is also an overproduction of oxygen free radical upon re-oxygenation. The implication of these differences is that a cyanotic heart is more prone to reperfusion injury not only after the release of aortic cross clamp but also on institution of cardiopulmonary bypass if hyperoxic bypass strategy is used [19,20,[24][25][26]. At the same time, there is also decreased 5` nucleotidase activity in the pediatric heart which results in a maintained nucleic acid pool which is essential for the recovery of energy debt when perfusion is resumed.…”

“…The pulmonary vasculature is more reactive in children and there are some intra or extra cardiac shunts which are active or patent in the neonatal heart [26]. The pediatric heat therefore tolerates ventricular distension and residual lesions poorly and exhibits a greater negative inotropic response to anesthetic drugs and poor response to inotropes.…”

“…There is more interventricular interdependence and the pediatric heart is more rate dependent for cardiac output than the adult. Due to the presence of shunt lesions there might be diastolic steal of blood during cardiopulmonary bypass which further affects myocardial perfusion and protection [18][19][20][21][22][23][24][25][26][27][28][29][30].…”

“…A proposed explanation ofthis difference is that, the mechanisms responsible for ischemic preconditioning may already be active in the immature heart [20,[21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

Leukocyte-depleted Continuous Blood Cardioplegia for Coronary Artery Bypass Grafting

“…[3][4][5] Recent studies have shown that myocardial injury can occur when the hypoxic heart is suddenly reoxygenated (as occurs with cardiopulmonary bypass) resulting in myocardial functional depression, impaired oxygenation, and increased pulmonary vascular resistance. 6) To achieve more effective myocardial protection, coronary bypass grafting (CABG) has been performed using continuous blood cardioplegia. In this study, we tested whether leukocyte-depleted cardioplegia solutions provide additional myocardial protection for CABG.…”