The Clinical Effects of Leukocyte Depletion Arterial Filter in Long duration Cardiopulmonary Bypass

Activated leukocytes play key role in generalized systemic inflammatory response during and after cardiopulmonary bypass (CPB). To minimize or even to prevent post-operative tissue injury, the various methods have been used nearly in all stages of inflammatory pathways. The most common leukocyte filtration strategy is to use leukocyte depletion arterial filter throughout the CPB.

To analyse the clinical effects of leukocyte arterial filter in long duration CPB along with its effect on myocardial reperfusion arrhythmia in comparison to regular arterial filter during and after CPB.

From March 2011 to January 2012, we enrolled 30 patients for a prospective randomised clinical study at author's institution. Patients were divided into two groups: 15 patients in study group underwent for cardiac surgery leukocyte arterial line filter (LG 6, Pall Biomedical, UK) were used during CPB. In control group 15 patient in which regular arterial filter (Dideco 734, Sorin Group, USA) were used during CPB. Blood samples were collected into EDTA anticoagulated coated tube for analysis of total count, differential counts as markers for leukocyte activation, neutrophils. Serum Separator Tube (SST II coated tube) for creatinine phoshpokinase (CPK), & Troponin I analysis for reperfusion arrhythmias in patient with CPB time >3 hour (5 patients from each group). Samples were taken at various phases of CPB, (i) 10 minutes of CPB, (ii) during rewarming phase, (iii) before termination of CPB & after every delivery of cardioplegia, 24 hours post-operatively. Duration of ventilation time, inotropic supports, reperfusion arrhythmias & length of intensive care unit (ICU) stay in both groups were evaluated.

Marked reduction in leukocyte count and neutrophils % after aortic clamp release and after wean off CPB resulted in minimal inotropic supports (Adrenaline and Dobutamine), good hemodynamic parameters, and no episodes of arrhythmias after wean off CPB. This indicated decrease in inflammatory reaction in study group patients. Evidences had confirmed better post-operative outcome in sstudy group patients with shorter average ventilation time, early extubation and shorter ITU stay compared to control group patients.

The study confirms the beneficial effect of leukocyte depleting filter to reduce systemic inflammation reaction & as well as reperfusion related arrhythmias during CPB & post-operative period.