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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2003 Aprile;44(2):197-204

lingua: Inglese

Does leukodepletion during elective cardiac surgery really influence the overall clinical outcome?

Efstathiou A., Vlachveis M., Tsonis G., Asteri T., Psarakis A., Fessatidis I. T.

Car­di­oth­o­racic Sur­gery Depart­ment George Pap­a­nik­o­laou Gen­eral ­Regional Hos­pital Exohi, Thes­sal­o­niki, ­Greece


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Aim. We exam­ined the ­impact of leu­ko­cyte fil­tra­tion ­during the ­entire ­bypass ­time on post­op­er­a­tive leu­ko­cy­tosis, per­i­op­er­a­tive hem­or­rhage and ­overall clin­ical out­come in ­patients under­going elec­tive car­diac sur­gery.
­Methods. ­Eighty ­patients who elec­tively under­went car­diac sur­gery ­were ran­domly allo­cated to a leu­ko­cyte deple­tion ­group (n=40) or a con­trol ­group (n=40). In ­patients of the leu­ko­cyte deple­tion ­group an arte­rial ­line ­filter ­with leu­ko­cyte ­depleting ­capacity (­Pall LG6) was ­applied ­instead of a stan­dard arte­rial ­line ­filter. ­White ­blood ­cells and ­platelet ­count ­were esti­mated pre­op­er­a­tively and at var­ious ­times post­op­er­a­tively. Post­op­er­a­tive clin­ical out­comes ­were ­also ­recorded.
­Results. ­Repeated ­measure anal­ysis of var­i­ance ­between ­groups ­showed ­that leu­ko­cyte ­counts ­were sig­nif­i­cantly ­lower in the deple­tion ­group post­op­er­a­tively (p=0.005) ­whereas no dif­fer­ence was ­found in the ­platelet ­counts (p=0.37). The cat­e­chol­a­mine ­dose ­required at the ­time of ­weaning ­from car­di­o­pul­mo­nary ­bypass and ­during the ­first 12 post­op­er­a­tive ­hours was ­found to be ­lower in the leu­kod­e­ple­tion ­group (p=0.027 and p=0.021, respec­tively). Fur­ther­more leu­ko­de­pleted ­patients ­showed a tran­sient improve­ment in the oxy­gen­a­tion ­index (p=0.029) and a ­shorter ­period of mechan­ical ven­ti­la­tion (p<0.001). The inci­dences of post­op­er­a­tive com­pli­ca­tions ­were sim­ilar ­between the ­groups. No dif­fer­ence was ­observed in ­regard to post­op­er­a­tive ­blood ­loss (p=0.821) and ­amount of ­packed red ­blood ­cells ­required for trans­fu­sion ­during the ­first 24 ­hours (p=0.846). The dura­tion of inten­sive ­care ­unit ­stay and of hos­pi­tal­iza­tion ­were sim­ilar ­between the ­groups.
Con­clu­sion. Leu­ko­cyte deple­tion con­trib­utes to ­early post­op­er­a­tive improve­ment in ­heart and ­lung func­tion but ­does not influ­ence sig­nif­i­cantly the ­overall clin­ical out­come of ­patients under­going elec­tive car­diac sur­gery.

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