Abstract

Objective: Cardiopulmonary bypass (CPB) induces a whole body inflammatory response that can lead to post-operative lung disfunction. Activated leukocytes play an important role in the pathogenesis of pulmonary dysfuncion. In our study we evaluate postoperative pulmonary function after the use of a leukocyte depletion filter incorporated in the extracorporeal circuit during CPB.

Methods: From April 1997 to March 1998 20 patients, electively or emergency undergoing aortic arch surgery using deep hypothermic CPB and circulatory arrest, were randomly allocated to a leukocyteñdepletion group (Group A, 10 pts.) or a control group (Group B, 10 pts.).

There were not significative difference for age, sex, weight, body surface area, temperature of cooling, duration of CPB in the two groups.

Blood samples were drawn preoperative, 60 minutes after CPB on, at aortic declamping, at the arrive in Intensive Care Unit (ICU) and 24 hours after operation, we analized blood cell counts and, neutrophil elastase concentration. After discontinuation of CPB, continuous monitorization of arterial blood gases was made during the stay in ICU.

Results: We observed a significative reduction in leukocyte count (WBC X10/mm) at the arrive in ICU in the group A (7.9 ± 3.5) compared with the control group (11.2 ± 3.2) (P < 0.05).

Gas exchange function (PaO2/FiO2) expressed like a curve was significatly better in group A (P < 0.05).

Timing of extubation (hrs) was lower in group A (42 ± 31) compared with group B (62 ± 51); the stay (hrs) in ICU was also lower in group A (50 ± 31) compared with group B (72 ± 51)

We did not observe significant difference between the two groups in term of neurological and infective complications, postoperative bleeding, needing of trasfusion and platelet count.

Conclusions: Use of leukocyte-depletion filter may contribute to improve lung function parameters after deep hypothermic CPB and circulatory arrest.