LEUKOCYTE AND PLATELET DEPLETION WITH A BLOOD-CELL SEPARATOR - EFFECTS ON LUNG INJURY AFTER CARDIAC-SURGERY WITH CARDIOPULMONARY BYPASS

This study was undertaken to assess the effects of leukocyte and plate let depletion on postoperative lung injury in 42 patients who underwen t heart operations. Blood was serially sampled before, during, and aft er cardiopulmonary bypass, and leukocyte count, platelet count, and th romboxane B-2 6-keto-PGF(1 alpha), leukocyte elastase, thrombin-antith rombin III complex, and D-dimer levels were determined. Postoperative respiratory function was assessed based on analyses of oxygenation and carbon dioxide elimination. Leukocyte and platelet depletion was perf ormed in 21 patients (experimental group) but not in another (control group), In the experimental group, leukocytes and platelets were remov ed continuously by means of the blood cell separator CS-3000, beginnin g immediately after the start of the operation and ending 1 hour after the release of aortic occlusion. Leukocyte elastase, thromboxane B-2, ratio of thromboxane B-2 to 6-keto-PGF(1 alpha), thrombin-antithrombi n III complex, and D-dimer were significantly lower in the experimenta l group than in the control group. Of the various indexes of oxygenati on, arterial oxygen tension was significantly higher in the experiment al group and the alveolar-arterial oxygen pressure difference and resp iratory index were significantly lower in the experimental group. The positive end-expiratory pressure needed to achieve an appropriate arte rial oxygen tension was significantly lower in the experimental group. The elimination of carbon dioxide was lower in the experimental group . Depletion of leukocytes and platelets reduced respiratory dysfunctio n after heart operations with cardiopulmonary bypass. It was particula rly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of cardiopulmonary bypass wa s required.