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Thorac Cardiovasc Surg 2003; 51(5): 249-254
DOI: 10.1055/s-2003-43082
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

Leukocyte-depleted Secondary Blood Cardioplegia Attenuates Reperfusion Injury after Myocardial Ischemia

A.  Civelek1 , M.  Roth1 , P.  Lemke1 , W.  P.  Klövekorn1 , E.  P.  Bauer1
  • 1Department of Thoracic and Cardiovascular Surgery, Bad Nauheim, Germany
Further Information

Publication History

Received: April 8, 2003

Publication Date:
22 October 2003 (online)

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Abstract

Background: Activated neutrophils have been implicated in reperfusion injury of the myocardium; leukocyte depletion at the time of reperfusion may contribute to better myocardial protection after cardiac surgery. In the present study, we examined whether leukocyte depletion as an adjunct to terminal blood cardioplegia attenuates reperfusion injury. Methods: Porcine hearts that had undergone 60 minutes of normothermic ischemia with cardioplegia and 60 minutes of reperfusion under cardiopulmonary bypass were divided into four groups according to the methods of 15 min of controlled initial reperfusion: whole blood reperfusion (n = 6), leukocyte-depleted reperfusion (n = 6), secondary blood cardioplegia (n = 6) and leukocyte-depleted secondary blood cardioplegia (n = 6). At 60 min of reperfusion, hemodynamic recovery, release of malondialdehyde (MDA) as a marker for free oxygen radicals, CK-MB-isoenzyme from the coronary sinus, recovery of adenosine triphosphate, and myocardial water content were evaluated. Results: The group with leukocyte-depleted secondary blood cardioplegia showed the best hemodynamic recovery (Emax and total dp/dt), lowest levels of MDA, CK-MB and myocardial water content, and highest adenosine triphosphate recovery. Conclusions: These results suggest that controlled reperfusion with leukocyte-depleted secondary blood cardioplegia attenuated severe damage of the myocardium as compared to whole blood reperfusion.

Key words

Leukocyte depletion - reperfusion - secondary blood cardioplegia - myocardial recovery

References

  • 1 Sawa Y, Matsuda H. Myocardial protection with leukocyte depletion in cardiac surgery.  Semin Thorac Cardiovasc Surg. 2001;  13 (1) 73-81
    PubMedGoogle Scholar
  • 2 Sawa Y, Matsuda H, Shimazaki Y, Kaneko M, Nishimura M, Amemiya A, Sakai K, Nakano S. Evaluation of leukocyte-depleted terminal blood cardioplegic solution in patients undergoing elective and emergency coronary artery bypass grafting.  J Thorac Cardiovasc Surg. 1994;  108 1125-1131
    PubMedGoogle Scholar
  • 3 Breda M A, Drinkwater D C, Laks H, Bhuta S, Corno A F, Davtyan H G, Chang P. Prevention of reperfusion injury in the neonatal heart with leukocyte-depleted blood.  J Thorac Cardiovasc Surg. 1989;  97 654-665
    PubMedGoogle Scholar
  • 4 Fukushima N, Shirakura R, Nakata S, Kaneko M, Sawa Y, Matsuwaka R, Naka Y, Matsumiya G, Matsuda H. Effects of terminal cardioplegia with leukocyte-depleted blood on heart grafts preserved for 24 hours.  J Heart Lung Transplant. 1992;  11 676-682
    PubMedGoogle Scholar
  • 5 Wilson I C, Gardner T J, DiNatale J M, Gillinov A M, Curtis W E, Cameron D E. Temporary leukocyte depletion reduces ventricular dysfunction during prolonged postischemic reperfusion.  J Thorac Cardiovasc Surg. 1993;  106 805-810
    PubMedGoogle Scholar
  • 6 Sawa Y, Taniguchi K, Kadoba K, Nishimura M, Ichikawa H, Amemiya A, Kuratani T, Matsuda H. Leukocyte depletion attenuates reperfusion injury in patients with left ventricular hypertrophy.  Circulation. 1996;  93 (9) 1640-1646
    PubMedGoogle Scholar
  • 7 Hayashi Y, Sawa Y, Nishimura M, Ichikawa H, Kagisaki K, Ohtake S, Matsuda H. Clinical evaluation of leukocyte-depleted blood cardioplegia for pediatric open heart operation.  Ann Thorac Surg. 2000;  69 1914-1919
    CrossrefPubMedGoogle Scholar
  • 8 Yamauchi H. Efficacy of leukocyte-depleted terminal blood cardioplegia in congenital heart disease.  Jpn J Thorac Cardiovasc Surg. 2000;  48 435-439
    PubMedGoogle Scholar
  • 9 Schaper J, Schaper W. Reperfusion of ischemic myocardium: ultrastructural and histochemical aspects.  J Am Coll Cardiol. 1983;  1 1037-1046
    PubMedGoogle Scholar
  • 10 Engler R L, Schmid-Schoenbein G W, Pavelec R S. Leukocyte capillary plugging in myocardial ischemia and reperfusion in the dog.  Am J Pathol. 1983;  111 98-111
    PubMedGoogle Scholar
  • 11 Bagchi D, Das D K, Engelman R M, Prasad M R, Subramanian R. Polymorphonuclear leucocytes as potential source of free radicals in the ischemic-reperfused myocardium.  Eur Heart J. 1990;  11 800-813
    PubMedGoogle Scholar
  • 12 Pala M G, Paolini G, Paroni R, Veechi E de, Gallorini C, Stefano P L, Credico G di, Zuccari M, Galli L, Agape V. Myocardial protection with and without leukocyte depletion: a comparative study on the oxidative stress.  Eur J Cardiothorac Surg. 1995;  9 701-706
    CrossrefPubMedGoogle Scholar
  • 13 Bando K, Pillai R, Cameron D E, Brawn J D, Winkelstein J A, Hutchins G M, Reitz B A, Baumgartner W A. Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypass.  J Thorac Cardiovasc Surg. 1990;  99 873-877
    PubMedGoogle Scholar
  • 14 Browning P G, Pullan M, Jackson M, Rashid A. Leucocyte-depleted cardioplegia does not reduce reperfusion injury in hypothermic coronary artery bypass surgery.  Perfusion. 1999;  14 (5) 371-377
    PubMedGoogle Scholar
  • 15 Carlson R E, Schott R J, Buda A J. Neutrophil depletion fails to modify myocardial no reflow and functional recovery after coronary reperfusion.  J Am Coll Cardiol. 1989;  14 1803-1813
    PubMedGoogle Scholar
  • 16 Allen S M, Pagano D, Bonser R S. Pall leukocyte depleting filter during cardiopulmonary bypass.  Ann Thorac Surg. 1994;  58 1560-1561
    PubMedGoogle Scholar
  • 17 Mehta J L, Nichols W W, Mehta P. Neutrophils as potential participants in acute myocardial ischemia: relevance to reperfusion.  J Am Coll Cardiol. 1988;  11 1309-1316
    PubMedGoogle Scholar
  • 18 di Salvo C, Louca L L, Pattichis K, Hooper J, Walesby R K. Does activated neutrophil depletion on bypass by leukocyte filtration reduce myocardial damage? A preliminary report.  J Cardiovasc Surg. 1996;  37 93-100
    PubMedGoogle Scholar
  • 19 Yaku H, Goto Y, Futaki S, Ohgoshi Y, Kawaguchi O, Suga H. Ventricular fibrillation does not depress postfibrillatory contractility in blood-perfused dog hearts.  J Thorac Cardiovasc Surg. 1992;  103 514-520
    PubMedGoogle Scholar
  • 20 Okazaki Y, Cao Z L, Ohtsubo S, Hamada M, Naito K, Rikitake K, Natsuaki M, Itoh T. Leukocyte-depleted reperfusion after long cardioplegic arrest attenuates ischemia-reperfusion injury of the coronary endothelium and myocardium in rabbit hearts.  Eur J Cardiothorac Surg. 2000;  18 90-97
    CrossrefPubMedGoogle Scholar
  • 21 Bull A W, Marnett L J. Determination of malondialdehyde by ion-pairing high-performance liquid chromatography.  Anal Biochem. 1985;  149 284-290
    CrossrefPubMedGoogle Scholar
  • 22 Tomoeda H. Effects of leukocyte-depleted warm blood cardioplegia on cardiac and endothelial function.  Kurume Med J. 1999;  46 31-38
    PubMedGoogle Scholar
  • 23 Kofsky E R, Julia P L, Buckberg G D, Quillen J E, Acar C. Studies of controlled reperfusion after ischemia. XXII. Reperfusate composition: effects of leukocyte depletion of blood and blood cardioplegic reperfusates after acute coronary occlusion.  J Thorac Cardiovasc Surg. 1991;  101 350-359
    PubMedGoogle Scholar
  • 24 Schmidt F E, MacDonald M J, Murphy C O, Brown W M, Gott J P, Guyton R A. Leukocyte depletion of blood cardioplegia attenuates reperfusion injury.  Ann Thorac Surg. 1996;  62 1691-1696
    CrossrefPubMedGoogle Scholar
  • 25 Hiramatsu Y, Koishizawa T, Matsuzaki K, Enomoto Y, Sakakibara Y. Leukocyte-depleted blood cardioplegia reduces cardiac troponin T release in patients undergoing coronary artery bypass grafting.  Jpn J Thorac Cardiovasc Surg. 2000;  48 625-631
    PubMedGoogle Scholar

Matthias Roth

Department of Thoracic and Cardiovascular Surgery, Kerckhoff Clinic Foundation

Benekestraße 2-8

61231 Bad Nauheim, Germany

Phone: +49 (6032) 996-2502

Fax: +49 (6032) 996-2567

Email: Matthias.Roth@kerckhoff.med.uni-giessen.de

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