Clinical evaluation of leukocyte filtration as an alternative anti-inflammatory strategy to aprotinin in high-risk patients undergoing coronary revascularization

Abstract

The use of aprotinin in cardiac surgery is associated with overriding safety concerns. Therefore, there is increased research on alternatives. This study investigated the relative benefits of strategic leukofiltration on polymer-coated extracorporeal circuits (ECC), aprotinin, and combined therapy in high-risk patients. Eight hundred and seventy-five patients (EuroSCORE 6+) undergoing coronary revascularization over a 4-year period were prospectively randomized to one of four perfusion protocols: Group 1: polymethoxyethylacrylate (PMEA)-coated circuits + leukocyte filters (n=214); Group 2: uncoated ECC + full Hammersmith aprotinin (n=212); Group 3: PMEA-coated ECC + leukofilters + full Hammersmith aprotinin (n=199); and Group 4: control-no treatment (n=250). Blood samples were collected at times T1: following the induction of anesthesia; T2: following heparin administration; T3: 15min after cardiopulmonary bypass (CPB); T4: before cessation of CPB; T5: 15min after protamine reversal; and T6: in the intensive care unit. The serum interleukin-2 levels were significantly lower at T3, T4, and T5 in all study groups. C3a levels were significantly lower at T3. Creatine kinase MB and lactate levels demonstrated well-preserved myocardia in both leukofiltration groups (P<0.05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups. Postoperative bleeding and respiratory support time were lower in all study groups. Leukofiltration on coated circuits significantly reduced bleeding and inflammatory response related to CPB with no adverse effects, and may be a possible alternative to pharmacological intervention.