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Ann Thorac Surg 1998;65:107-113
© 1998 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Effects of Depletion of Leukocytes and Platelets on Cardiac Dysfunction After Cardiopulmonary Bypass

The Second Department of Surgery, Fukui Medical School, Fukui, Japan

Accepted for publication July 7, 1997.

Dr Chiba, The Second Department of Surgery, Fukui Medical School, 23-3 Shimoaizuki, Matsuoka-cho, Yoshida-gun, Fukui-ken, 910-11 Japan.

Background. This study examined the effects of the depletion of leukocytes and platelets from circulated blood on cardiac function after cardiopulmonary bypass in 37 patients who underwent coronary artery bypass grafting or aortic valve replacement.

Methods. Leukocytes and platelets were removed continuously using a blood cell separator, beginning immediately after the start of the operation and ending 1 hour after the release of the aortic cross-clamp in 19 patients (LPD group), but not in the remaining 18 patients (control group). Blood cell counts and levels of thromboxane B₂, 6-keto-prostaglandin F₁, leukocyte elastase, complements C3a and C4a, thrombin-antithrombin III complex, and 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 required to support the circulation in the early postoperative period also were assessed.

Results. Leukocyte and platelet counts and levels of leukocyte elastase, thromboxane B₂, thromboxane₂/6-keto- prostaglandin F₁, thrombin-antithrombin III complex, and D-dimer were significantly lower in the LPD group than in the control group before and after the release of the aortic cross-clamp and during the perioperative period. There were no significant differences in the levels of 6-keto-prostaglandin F₁ or complements C3a and C4a between the two groups. The catecholamine dose was significantly lower in the LPD group than in the control group (1.1 ± 2.5 versus 5.0 ± 5.2 mg/kg, respectively). Fewer patients required the use of nitroprusside as a vasodilator in the LPD group than in the control group (1/19 versus 12/18, respectively).

Conclusions. The depletion of leukocytes and platelets using a blood cell separator prevents the deterioration of cardiac function after cardiac operations using cardiopulmonary bypass.

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