Abstract
Purpose
To determine whether inclusion of a neutrophil-specific filter into the extracorporeal circuit during open heart valve surgery alters postoperative outcomes.
Methods
Convenience sampling of 24 patients undergoing elective open heart valve surgery between July 1993 and June 1994. Patients were randomized to a neutrophil-specific filter (n= 11) or to a standard blood filter (n= 13) during cardiopulmonary bypass.
Results
Neutrophil-specific filter diminished (P < 0.02) the expression of CD 18, a neutrophil surface adhesion molecule, at 1 (84.5 ± 4.2 vs 94.8 ± 3.8%). 4 (80.0 ± 4.2 vs 95.1 ± 3.9%) and 24 hr (75.2 ± 4.2 vs 98.2 ±3.9%) post-operatively compared with standard filter. Total white blood cell count, neutrophil count, and proinflammatory cytokmes (IL-6, IL-8) were similar between groups at all times. Measured outcomes including: PaO2, cardiac index, ejection fraction, haemodynamic variables, use of motropes, spirometry (FEV FVC). and hospitalization duration were similar between groups.
Conclusions
Inclusion of the neutrophil filter during open heart valve surgery selectively depletes activated neutrophils. There were no other detectable differences between the two groups and the use of a neutrophilspecific filter in routine clinical practice for patients undergoing open heart valve surgery is not supported.
Résumé
Objectif
Déterminer si l’ajout au circuit extracorporel d’un filtre spécifique aux neutrophiles pendant une chirurgie valvulaire modifiait les résultats de l’intervention
Méthodes
Un échantillonnage de 24 patients subissant une intervention valvulaire à coeur ouvert entre juillet 1993 et juin 1994. Les patients ont été répartis aléatoirement à un circuit extracorporel incluant un filtre spécifique aux neutrophiles (n= 11) ou un filtre standard (n= 13).
Résultats
Le filtre spécifique aux neutrophiles a diminué l’expression de CD 18. une molécule adhésive de sur face, une heure (84.5 ± 4.2 vs 98.8 ± 3.8%), quatre heures (80 ± 4,2 vs 95.1 ± 3,9%) et 24 heures (75.2 ± 4,2 vs 98.2 ± 3.9%) après l’opération comparativement au filtre standard. Le décompte total des globules blancs, des neutrophiles et des cytokines pro-inflammatoires (IL-6. IL8) étaient à tous les moments identiques entre les groupes. Les mesures de résultats incluant la PaO2, l’index cardiaque, la fraction d’éjection, les données hémodynamiques, l’utilisation d’inotropes, la spirométne (VEMS, CVF) et la durée du séjour hospitalier étaient identiques entre les groupes.
Conclusion
L’ajout d’un filtre spécifique aux neutrophiles pendant la chirurgie à coeur ouvert épuise sélectivement les neutrophiles activés. Aucune autre différence n’est discernable entre les groupes. L’utilisation courante de filtres spécifiques aux neutrophiles en clinique chez des patients soumis à une chirurgie valvulaire à coeur ouvert n’est pas justifiée.
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Abbreviations
- CABG:
-
coronary artery bypass graft
- CPB:
-
cardiopulmonary bypass
- IL-6:
-
interleukin 6
- IL-8:
-
interleukin 8
- PSA :
-
systemic arterial pressure
- PRA :
-
right atrial pressure
- PPA :
-
pulmonary artery pressure
- PCWP :
-
pulmonary capillary wedge pressure
- CI:
-
cardiac index
- WBC:
-
white blood cell count
- IL-6SR:
-
interleukin 6 soluble receptor
- FAS:
-
fractional shortening
- EF:
-
ejection fraction
- A-aDO2 :
-
aveolar to arterial difference for oxygen
- Qs/Qt:
-
intrapulmonary shunt
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Hurst, T., Johnson, D., Cujcc, B. et al. Depletion of activated neutrophils by a filter during cardiac valve surgery. Can J Anaesth 44, 131–139 (1997). https://doi.org/10.1007/BF03013000
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DOI: https://doi.org/10.1007/BF03013000