Publication: The effect of neutrophil depletion from blood cardioplegia on myocardial ischemia/reperfusion injury
Abstract
Amaç: Nötrofillerden arınmış kan kardiyoplejisinin iskemi/ reperfüzyon hasarına karşı koruyucu rolü olup olmadığı araştırıldı. Çalışma planı: Çalışmaya, koroner arter bypass greftleme (KABG) uygulanan ve sol ventrikül fonksiyonları iyi olan 16 erkek hasta alındı. Hastalar rastgele olarak, sayıca eşit iki gruba ayrıldı. Bir gruba antegrad/retrograd soğuk kan kardiyoplejisi lökosit filtresi takılarak, diğer gruba ise filtre takılmadan uygulandı. Dokuda nötrofil birikiminin belirteci olan doku miyeloperoksidaz (MPO) aktivitesinin belirlenmesi için, kardiyopulmoner bypass başlangıcında, kros klemp konmadan hemen önce ve kros klempin çıkarılmasından bir saat sonra interventriküler septumdan biyopsi örnekleri alındı. Kardiyopulmoner bypass öncesinde ve kros klempin çıkarılmasından dört saat sonra hastaların kardiyak indeksleri hesaplandı. Kreatin kinaz-MB (CKMB) aktivitesi ameliyat gününde altı saatte bir ölçüldü. Bulgular: Filtreleme yapılan grupta kardiyopleji sıvısındaki ortalama lökosit sayısı anlamlı derecede düşük bulundu (p<0.001). İki grup arasında kardiyak indeksler, CK-MB düzeyleri, mekanik destek, ciddi ventrikül aritmisi gelişimi ve inotropik ajan ihtiyacı açısından anlamlı farklılık bulunmadı (p>0.05). Kros klemp öncesinde, lökosit filtresi uygulanan ve uygulanmayan gruplarda doku MPO aktivitesi sırasıyla 0.13±0.04 U/100 mg doku ve 0.11±0.04 U/100 mg doku bulundu. Kros klempin çıkarılmasından bir saat sonra, MPO aktivitesi her iki grupta da anlamlı artış gösterdi. Lökosit filtresi uygulanan grupta MPO aktivitesindeki artış daha düşük olmasına karşın bu farklılık anlamlı değildi (p>0.05). Sonuç: Sol ventrikül fonksiyonları iyi olan ve elektif KABG ameliyatı yapılacak hastalarda, kan kardiyoplejisinden nötrofilleri arındırmak, hemodinamik ve biyokimyasal parametreler açısından ek yarar sağlamamaktadır.
Background: We investigated whether depleting neutrophils from blood cardioplegia had a protective role against ischemia/reperfusion injury. Methods: The study included 16 male patients who underwent coronary artery bypass grafting (CABG) and had good left ventricular functions. The patients were randomly divided into two groups equal in number, depending on the administration of antegrade/retrograde cold blood cardioplegia with or without a leukocyte filter. To determine tissue myeloperoxidase (MPO) activity, an indicator of neutrophil accumulation, biopsies were obtained from the interventricular septum after institution of cardiopulmonary bypass (CPB), before placing the aortic cross-clamp, and one hour after its removal. Cardiac indices were calculated before the institution of CPB and four hours after the removal of the aortic cross-clamp. Creatine kinase-MB (CK-MB) activity was measured every six hours on the day of the operation. Results: With the use of filtering, the mean leukocyte count in cardioplegia was significantly reduced (p<0.001). The two groups did not differ significantly with respect to cardiac indices, CK-MB levels, mechanical support, development of severe ventricular arrhythmias, and the use of inotropic agents (p>0.05). Tissue MPO activities before aortic crossclamping were 0.13±0.04 U/100 mg tissue and 0.11±0.04 U/100 mg tissue with and without leukocyte filtering, respectively. One hour after aortic cross-clamp removal, MPO activity showed a significant increase in both groups. Leukocyte filtering was associated with a smaller increase in MPO activity, but this did not reach significance (p>0.05). Conclusion: Depletion of neutrophils from blood cardioplegia in patients undergoing elective CABG with good left ventricular functions yielded no additional benefits in terms of hemodynamic or biochemical parameters.
Background: We investigated whether depleting neutrophils from blood cardioplegia had a protective role against ischemia/reperfusion injury. Methods: The study included 16 male patients who underwent coronary artery bypass grafting (CABG) and had good left ventricular functions. The patients were randomly divided into two groups equal in number, depending on the administration of antegrade/retrograde cold blood cardioplegia with or without a leukocyte filter. To determine tissue myeloperoxidase (MPO) activity, an indicator of neutrophil accumulation, biopsies were obtained from the interventricular septum after institution of cardiopulmonary bypass (CPB), before placing the aortic cross-clamp, and one hour after its removal. Cardiac indices were calculated before the institution of CPB and four hours after the removal of the aortic cross-clamp. Creatine kinase-MB (CK-MB) activity was measured every six hours on the day of the operation. Results: With the use of filtering, the mean leukocyte count in cardioplegia was significantly reduced (p<0.001). The two groups did not differ significantly with respect to cardiac indices, CK-MB levels, mechanical support, development of severe ventricular arrhythmias, and the use of inotropic agents (p>0.05). Tissue MPO activities before aortic crossclamping were 0.13±0.04 U/100 mg tissue and 0.11±0.04 U/100 mg tissue with and without leukocyte filtering, respectively. One hour after aortic cross-clamp removal, MPO activity showed a significant increase in both groups. Leukocyte filtering was associated with a smaller increase in MPO activity, but this did not reach significance (p>0.05). Conclusion: Depletion of neutrophils from blood cardioplegia in patients undergoing elective CABG with good left ventricular functions yielded no additional benefits in terms of hemodynamic or biochemical parameters.