LEUKOCYTE DEPLETION ATTENUATES REPERFUSION INJURY IN PATIENTS WITH LEFT-VENTRICULAR HYPERTROPHY

Background Reperfusion injury can occur after a long period of aortic cross-clamping in patients with left ventricular hypertrophy during op en-heart surgery, even with the most up-to-date techniques of myocardi al protection. In the present study, we examined whether leukocyte dep letion as an adjunct to terminal blood cardioplegia (LDTC) attenuates reperfusion injury in patients with left ventricular hypertrophy (LV m ass, >300 g; left ventricular end-systolic volume index, >100 mL/m(2)) in a group of 30 patients undergoing aortic valve replacement. Method s and Results We used basic cold potassium crystalloid cardioplegic so lution. Terminal blood cardioplegic solution (TC) or LDTC was accompli shed by mixing a cold potassium crystalloid cardioplegic solution with warm arterial blood obtained through cardiopulmonary bypass and admin istered to the aortic root for the first 10 minutes of reperfusion. Du ring delivery of LDTC, warm arterial blood was passed through a leukoc yte-removal filter. Patients were randomized into one of three groups for reperfusion: whole blood (WE) (n-10), TC (n=10), and LDTC (n=10). Left ventricular biopsies were obtained before ischemia, at the end of ischemia, and 15 minutes after repel fusion. Semiquantitative scoring for ultrastructural alterations indicated that the LDTC group achieve d significantly better recoveries of both scores at reperfusion for my ocyte damage and for endothelial cell damage of capillaries than did t he WE and TC groups. The LDTC group had significantly fewer neutrophil s adhering to endothelial cells at reperfusion and a lower level of ma londialdehyde derived from myocardium than did the WE and TC groups. R egarding the clinical data, the LDTC group had a lower maximum creatin e kinase-MB, a higher percentage of spontaneous defibrillation, a lowe r pulmonary capillary wedge pressure, and a lower requirement for dopa mine than did the WE group, whereas the TC group failed to do better t han the WE group. Conclusions These results demonstrate that leukocyte -depleted reperfusion is potentially beneficial as an adjunct to termi nal cardioplegia during cardiac surgery to attenuate reperfusion injur y in patients with left ventricular hypertrophy.