The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery

Whitaker, Donald; Newman, Stanton; Stygall, Jan; Hope-Wynne, Chris; Harrison, Michael J.; Walesby, R.K.

doi:10.1016/j.ejcts.2003.11.007

Cited by 63 publications

(38 citation statements)

References 17 publications

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“…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].…”

Section: Does Systemic Leukofiltration Reduce Leukocyte Counts?mentioning

confidence: 95%

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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Section: Does Systemic Leukofiltration Reduce Leukocyte Counts?mentioning

confidence: 95%

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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“…In this patient, we identified no patient characteristics, intraoperative events, or other predisposing factors that may have influenced this result. The outlier's NP performance showed improvement between the intervals and this suggests the relationship between microemboli and NP outcome is complex as established by numerous studies in cardiac surgery, most pertinently, a study by Whitaker et al investigating the effect of a leukocyte-depleting filter on cerebral microemboli and NP outcome in CABG [72]. They reported a reduction in microemboli but no major improvement in NP outcome.…”

Section: Discussionmentioning

confidence: 97%

“…Few studies implicate PFO as a possible conduit for embolic material to reach the systemic circulation [22,26,27,53,71,73], but no study attempted to identify the presence of PFO in vivo using validated techniques. After the findings in the study by Byrick et al in mongrel dogs, hypothesizing that transpulmonary passage of fat emboli was possible, PFO may not be the only route available for For the WOMAC score, 0 is the best score, reflecting low disability and pain; for the EuroQol score, 1.000 is the best result; for the Oxford hip score, 12 is the best score, ie, the disability caused by the hip is low; the Harris hip score results can be stratified as excellent (90-100), good (80-89), fair (70)(71)(72)(73)(74)(75)(76)(77)(78)(79), and poor (less than 70); 6.7% of patients were Trendelenburg-positive, 46.7% level and 37.8% negative at 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…There is much published work on patients undergoing cardiothoracic surgery, the incidence of cerebral microembolization, and the consequent neuropsychologic (NP) decline after coronary artery bypass grafting surgery (CABG) [13,46,50,55,69,72]. This decline is defined as an impairment of concentration, memory, learning, or the speed of mental and visuomotor responses (although not necessarily all of these).…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Patel

Stygall

Harrington

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundIntraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. Questions/purposes We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. Methods The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. Results Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. Conclusions Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.

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“…72 Arterial filters, in particular leukocyte-depleting filters, fat-removal filters, or an air bubble trap in the arterial line, could also considerably reduce the number of MESs. [73][74][75][76][77][78][79] Because the number of MESs is higher in cases of longer-duration CABG procedures, shorter operation times may prevent harm due to MESs. 80 In left heart valve replacement, the application of a new "dual-vent" de-airing technique could significantly reduce the number of carotid MESs.…”

Section: Monitoring Of Mess During Cardiac Surgerymentioning

confidence: 99%

Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures

Dittrich

Ringelstein

2008

Stroke

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Background and Purpose-Microembolic signals (MESs) are detectable within the transcranial Doppler frequency spectrum downstream from vascular atherothrombotic or cardiothrombotic lesions. A frequent occurrence of MESs has also been shown during bypass surgery or after mechanical valve implantation. We sought to compile the knowledge on MES prevalence, the clinical impact of these cardiogenic MESs, and microemboli composition. Summary of Review-We performed a systematic MEDLINE search and summarized the currently available literature about MESs during or after cardiosurgical procedures for this state-of-the-art report. Conclusions-The nature of cardiogenic MESs is heterogeneous, and their prevalence is highly variable, reflecting their different origin from a broad spectrum of cardiosurgical conditions. The occurrence and number of MESs during cardiac catheterization and percutaneous coronary angioplasty seem to have a clinical impact but need to be explored further.In patients with prosthetic heart valves, in those with left ventricular assist devices, and during cardiac surgery, the occurrence of MESs has an important clinical impact, and MES monitoring has proven its reliability.

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The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery

Abstract: LD filtration during CABG reduced the number of cerebral microemboli recorded by TCD and showed a strong trend towards improving NP performance post-operatively. These findings suggest that the use of such filters in CABG surgery may offer increased neuroprotection.

Cited by 63 publications

References 17 publications

The effects of various leukocyte filtration strategies in cardiac surgery

The effects of various leukocyte filtration strategies in cardiac surgery

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures

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