Strategic Leukofiltration in Cardiac Surgery

Abstract

Systemic inflammatory response syndrome (SIRS) with activation of molecular cascades, cell activation, accumulation of interstitial fluid, organ dysfunction and, occasionally, organ failure is still a commonly recognized consequence of cardiac surgery. SIRS leads to costly complications and several strategies intended to ameliorate the symptoms that have been studied, including leukocyte reduction, using filtration. Although, the body of work suggests that leukoreduction attenuates SIRS, discrepancies remain within the literature. The recent literature is reviewed highlighting the areas where concordance is lacking. In our study, on the basis of indirect indicators of SIRS, platelet function by thromboelastography biomaterial evaluation by light and scanning electron microscopy, we present our conclusions regarding clinical outcomes and the role of leukofiltration.

Clinical evaluation of leukocyte filtration as an alternative anti-inflammatory strategy to aprotinin in high-risk patients undergoing coronary revascularization

“…In addition, there was less need for inotropic support and IABP in the filtered groups. These findings were consistent with previous research [22]. Mechanical interventions do not affect organ function, but full-dose aprotinin in clinically ill patients may interfere with metabolic activities in the early post-CPB period.…”

Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?

“…Our previous studies indicated that leukocyte filters on uncoated circuits caused a pressure difference and platelet destruction (5,17,18). The uncoated surface induced an activation of platelets and complemented the inflammatory process.…”

“…Also filtration efficiency and duration was much better with additional coating. In our previous studies, we have compared leukocyte filtration on coated and uncoated circuits and concluded that leukofiltration on uncoated circuits did not have any additional advantage, even interfered platelet preservation (17,18).…”

Perioperative planning in the COVID-19 pandemic: Cardiovascular perfusion and device-related issues

“…Accumulating evidence have suggested that a subgroup of patients with severe COVID-19 may have a cytokine storm syndrome. [3] We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality rates. Secondary hemophagocytic lymphohistiocytosis is a syndrome characterized by a fulminant and fatal hypercytokinemia associated with multiorgan failure.…”

“…Cytokine filtration (extracorporeal blood purification) is approved by the United States Food and Drug Administration (FDA) to treat patients 18 years of age or older with confirmed COVID-19 admitted to the operating room/intensive care unit with confirmed or imminent respiratory failure to reduce pro-inflammatory cytokines levels. [3] The issue of potential risk for aerosolization/ contamination of virus via oxygenator/chest drains is also an under-recognized means of viral spread, which may put patients and healthcare professionals at an utmost risk for infection. Although most membrane oxygenators used today are surface coated, there is no evidence-based in the literature to suggest that viruses cannot permeate these hollow fiber materials.…”