Clinical efficacy of two-phase leukocyte filtration in high-risk patients undergoing coronary revascularization with cardiopulmonary bypass.

The purpose of this study was to investigate the clinical outcome, inflammatory response and myocardial function in high-risk patients undergoing three different leukocyte depletion strategies. Over a four-month period, forty patients (EuroSCORE 6+) undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1 (N=10): Conventional circuits (ECC) + two leukocyte filters (LG6B, Pall, USA) with the method of two-phase (continuous + strategic) leukofiltration; Group 2 (N=10): ECC + single leukocyte filter with the method of continuous leukofiltration; Group 3 (N=10): ECC + single leukocyte filter with the method of strategic leukofiltration; Group 4 (N=10) CONTROL: ECC without leukocyte filtration. Blood samples were collected at T1: Baseline, T2: On CPB, T3: X-Clamp, T4: Off CPB, T5: ICU24 and T6: ICU48. Perioperative follow-up was thoroughly monitored. Leukocyte counts in double filter and strategic filtration groups demonstrated significant differences at T4 (p < .05 vs. control). TNFalpha levels were significantly lower in Group 1 at T4 and procalcitonin levels at T5 and T6 (p < .05 vs. control). CKMB levels demonstrated well preserved myocardium in double filter group (p < .05 vs. control). Brain natriuretic peptide levels in double filter group were significantly lower at T5 and T6 with respect to Group 2 (p <.05) and control (p <.001). Matrixmetallopeptidase 9 and D-Dimer levels in double filter group were significantly lower at T5 and T6 (p <.05 vs. control).Two-phase leukofiltration is associated with some compound benefit over continuous deployment in high-risk patients. A larger more powerful study than this pilot one is warranted for further evaluation.