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Ann Thorac Surg 1993;55:12-19
© 1993 The Society of Thoracic Surgeons
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland USA
* Address reprint requests to Dr Gardner, Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Blalock 618, Baltimore, MD 21205.
Neonatal cardiac surgical procedures continue to be associated with a considerable incidence of severe post-operative ventricular dysfunction. The role of neutrophils in mediating such injury has recently been proposed but remains controversial. The present study was undertaken to examine the potential benefits of leukocyte depletion for myocardial preservation using an in situ, in vivo porcine model of neonatal cardiac surgery. Sixteen 3- to 5-day-old piglets, 8 controls and 8 leukocyte-depleted animals (LD group), underwent 90 minutes of hypothermic ischemia. Mechanical leukocyte filtration during cardiopulmonary bypass reduced the granulocyte count in the initial reperfusate to 0.7% of controls. This was associated with a reduction in leukocyte sequestration in the coronary vascular bed (p < 0.005), a decrease in myocardial creatine kinase release (p < 0.02), and a reduction in coronary vascular resistance (p < 0.03). These changes in physiological response to ischemia were associated with improved postischemic recovery of left ventricular systolic function in LD animals (p < 0.05), although there was no significant improvement in diastolic function. Application of this technique in neonatal cardiac operations may improve myocardial protection and reduce the associated morbidity and mortality.
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