EFFECTS OF DEPLETION OF LEUKOCYTES AND PLATELETS ON CARDIAC DYSFUNCTION AFTER CARDIOPULMONARY BYPASS

Background. This study examined the effects of the depletion of leukoc ytes and platelets from circulated blood on cardiac function after car diopulmonary bypass in 37 patients who underwent coronary artery bypas s grafting or aortic valve replacement. Methods. Leukocytes and platel ets were removed continuously using a blood cell separator, beginning immediately after the start of the operation and ending 1 hour after t he release of the aortic cross-clamp in 19 patients (LPD group), but n ot in the remaining 18 patients (control group). Blood cell counts and levels of thromboxane B-2, 6-keto-prostaglandin F-1 alpha leukocyte e lastase, complements C3a and C4a, thrombin-antithrombin III complex, a nd D-dimer were determined periodically during and after the operation . The cardiac index, the difference between the central and peripheral core temperatures, and the doses of catecholamines and vasodilators r equired to support the circulation in the early postoperative period a lso were assessed. Results. Leukocyte and platelet counts and levels o f leukocyte elastase, thromboxane B-2, thromboxane(2)/6-keto-prostagla ndin F-1 alpha, thrombin-antithrombin III complex, and D-dimer were si gnificantly lower in the LPD group than in the control group before an d after the release of the aortic cross-clamp and during the periopera tive period. There were no significant differences in the levels of 6- keto-prostaglandin F-1 alpha or complements C3a and C4a between the tw o groups. The catecholamine dose was significantly lower in the LPD gr oup than in the control group (1.1 +/- 2.5 versus 5.0 +/- 5.2 mg/kg, r espectively). Fewer patients required the use of nitroprusside as a va sodilator in the LPD group than in the control group (1/19 versus 12/1 8, respectively). Conclusions. The depletion of leukocytes and platele ts using a blood cell separator prevents the deterioration of cardiac function after cardiac operations using cardiopulmonary bypass. (C) 19 98 by The Society of Thoracic Surgeons.