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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 805-810, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
IC Wilson, TJ Gardner, JM DiNatale, AM Gillinov, WE Curtis and DE Cameron
Leukocyte depletion improves early postischemic ventricular performance in
neonatal models of global myocardial ischemia. However, the rate of
leukocyte reaccumulation after cardiopulmonary bypass and its subsequent
impact on myocardial function is not known. This laboratory study examined
the effect of leukocyte depletion on myocardial performance during the
initial 6-hour period after bypass in an in situ, in vivo porcine model of
neonatal cardiac surgery. Fifteen 3- to 5-day-old piglets (eight control
and seven leukocyte depleted animals) were instrumented by placement of
left ventricular short-axis sonomicrometry crystals and an intraventricular
micromanometer catheter. Mechanical leukocyte depletion was achieved with
Pall RC100 filters (Pall Biomedical, Inc., Fajardo, Puerto Rico) in the
cardiopulmonary bypass circuit. Neonatal hearts were subjected to 90
minutes of hypothermic ischemia after a single dose of cold crystalloid
cardioplegia. Two control animals died after the operation and were
excluded from data analysis. Leukocyte filtration reduced the granulocyte
count during initial myocardial reperfusion to 0.8% of control values.
However, circulating granulocyte counts increased in leukocyte depleted
animals throughout the postoperative period, reaching 68% of control values
by 6 hours. Despite this rapid return of circulating granulocytes, animals
subjected to leukocyte depletion had significantly better preservation of
left ventricular performance (measured by preload recruitable stroke work,
p < or = 0.02), left ventricular systolic function (measured by
end-systolic pressure-volume relationship, p < or = 0.05), and
ventricular compliance (p < or = 0.04) during the experiment. These
changes in ventricular function were associated with a significant increase
in left ventricular water content (p < or = 0.02) and tissue
myeloperoxidase activity (p < or = 0.005) in control animals compared
with leukocyte depleted animals. This study demonstrates that leukocyte
depletion during initial reperfusion results in sustained improvement in
postischemic left ventricular function despite the rapid return of
granulocytes to the circulation.
ARTICLES
Temporary leukocyte depletion reduces ventricular dysfunction during prolonged postischemic reperfusion
Department of Cardiac Surgery, Johns Hopkins Medical Institution, Baltimore, Md. 21205.
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