The Role of Leukocyte Depletion in Reducing Injury to Myocardium and Lung During Cardiopulmonary Bypass

Hachida, M; Hanayama, Naoji; Okamura, Takashi; Akasawa, Toshimasa; Maeda, Takeshi; Bonkohara, Yukihiro; Endo, Masahiro; Hashimoto, A; Koyanagi, Hitoshi

doi:10.1097/00002480-199507000-00015

Cited by 48 publications

(52 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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]. Hachida et al showed a significantly lower WCC in the filtered group only at 15 min post-bypass measurement [54]. Johnson et al demonstrated lower WCCs at 1, 4 and 24 h post-operatively in the filtered cohort [55] and Efstathiou et al found that both groups had significantly elevated WCCs post-operatively, but that these were significantly lower in the depleted group [56].…”

Section: Does Systemic Leukofiltration Reduce Leukocyte Counts?mentioning

confidence: 98%

“…n/a 2 n/a n/a a, q, r, h 26 kinase-MB (CK-MB) and Troponin T or I. Most studies reported a 'trend' towards a decrease in these markers for filtered patients without, however, recording statistically significant differences [44,48,54]. In a recent large (n = 159) randomized trial, there was no difference between the filtered and control groups, for either cardiac marker [49].…”

Section: Does Systemic Leukofiltration Reduce Markers Of Systemic Infmentioning

confidence: 99%

See 1 more Smart Citation

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

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.

show abstract

Section: Does Systemic Leukofiltration Reduce Leukocyte Counts?mentioning

confidence: 98%

Section: Does Systemic Leukofiltration Reduce Markers Of Systemic Infmentioning

confidence: 99%

The effects of various leukocyte filtration strategies in cardiac surgery

Warren

Alexiou

Massey

et al. 2007

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Systemic leukofiltration had no effect on postoperative respiratory infection (OR, 1.06; 95% CI, 0.39 -2.91; p ϭ 0.90). There was a 48 2 7 Mihaljevic et al 37 1 5 Hachida et al 50 1 5 Lust et al 52 3 6 Di Salvo et al 51 1 8 Hurst et al 49 2 8 Baksass et al 53 1 8 Mair et al 36 1 6 Sahlman et al 54 1 1 1 Fabbri et al 35 1 9 Stefanou et al 58 1 1 0 Efstathiou et al 39 1 8 Sheppard et al 57 2 6 Alexiou et al 56 2 1 1 Karaiskos et al 55 1 1 2 Chen et al 63 2 7 Alexiou et al 59 2 1 2 Sheppard et al 60 1 6 Leal-Noval et al 62 2 1 0 Koskenkari et al 61 1 1 0 (Figure 4) within the treatment group although neither of these was statistically significant.…”

Section: Results From Overall Meta-analysismentioning

confidence: 99%

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

et al. 2008

View full text Add to dashboard Cite

Pulmonary injury mediated by activated leukocytes is a recognized complication of cardiopulmonary bypass. The aim of this paper is to systematically analyze the effects of systemic leukofiltration within the cardiopulmonary bypass circuit on pulmonary injury and related clinical outcomes. We performed a systematic search to identify randomized controlled trials reporting on the effects of systemic leukofiltration on respiratory parameters. Random effect meta-analytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity and subgroup analyses were undertaken to evaluate study heterogeneity. Incorporating 995 patients, 21 studies satisfied the inclusion criteria. Systemic leukofiltration significantly increased the PaO2/FiO2 ratio within 12 hours of bypass cessation, (weighted mean difference (WMD), 25.97; 95% confidence interval (CI), 3.41-48.53; p = 0.02) but this effect was lost by 24 hours (WMD, 12.98; 95% CI, -7.93-33.89; p = 0.22). Leukofiltration significantly reduced the duration of ventilatory support postoperatively (WMD, -2.11 hours; 95% CI, -0.65 to -3.58; p = 0.005), but had no impact on postoperative chest infection, intensive care length of stay or hospital length of stay. The heterogeneity of the included studies was high, due to poor quality study design and failure to include patients at high risk of pulmonary complications. Systemic leukofiltration may attenuate bypass-related lung injury in the early postoperative period, but this does not seem to translate to clinically significant differences in outcomes.

show abstract

“…Furthermore, in the absence of a leukocyte-depleting filter, arterial oxygen tension (PaO 2 ) has been shown to return to normal within 7 h after CPB [29]. In one study [30] the pulmonary index was worse in the control group in patients not receiving a leukocyte-depleting filter for up to 24 h after CPB. However, another study [31] found no clinical difference in respiratory function between either group, while another [32] found the early difference had disappeared by 24 h. Myocardial function in leukocyte-depleted patients has been demonstrated to be better [30,33] with lower creatine kinase-MB (CK-MB) concentrations and less inotrope requirements, when compared to non-leukocyte-depleted controls.…”

Section: Leukocyte Depletion During Cardiopulmonary Bypassmentioning

confidence: 99%

Mechanisms and Technical Aspects of Leukocyte Depletion

Sheppard¹

2001

Leukocyte Depletion in Cardiac Surgery and Cardiology

View full text Add to dashboard Cite

The Role of Leukocyte Depletion in Reducing Injury to Myocardium and Lung During Cardiopulmonary Bypass

Cited by 48 publications

References 0 publications

The effects of various leukocyte filtration strategies in cardiac surgery

The effects of various leukocyte filtration strategies in cardiac surgery

Systemic Leukofiltration Does Not Attenuate Pulmonary Injury after Cardiopulmonary Bypass

Mechanisms and Technical Aspects of Leukocyte Depletion

Contact Info

Product

Resources

About