Abstract
Objective: To prevent postoperative pulmonary dysfunction, we have investigated the effect of the Leuko-Guard 6 leukocyte-reducing arterial line filter (LG6) on postoperative lung function.Methods: Twenty-six cases of adult valvular heart disease were included in this study. Thirteen cases were operated upon using the LG6 (Group LG), and 13 cases were operated upon using a conventional arterial line filter (Group C). Neutrophil, polymorphonuclear leukocyte elastase and lipoperoxide were measured for this study, and the lung function was evaluated using the Oxygenation Index (PaO2/FiO2).Results: Statistically significant differences were observed in neutrophil counts between Group LG and Group C (LG = 2225 ± 572/mm3, C = 3157 ± 1413/mm36, p = 0.04) at 5 minutes after the onset of cardiopulmonary bypass. In simultaneous blood sampling from the pulmonary artery and the pulmonary vein, the sequestration of neutrophil in the lung decreased in Group LG after the discontinuation of cardiopulmonary bypass. Release of polymorphonuclear leukocyte elastase from the lungs was significantly decreased (p = 0.04) in the Group LG at 1 hour post-bypass. Significant differences were observed in the Oxygenation Index between Group LG and Group C (LG = 398 ± 72, C = 326 ± 71, p = 0.019) at 3 hours post-bypass.Conclusion: We concluded that LG6 improved the postoperative lung function, and its mechanism might be derived from the prevention of leukosequestration in the lungs that occurs during the rewarming phase due to selective absorption of activated leukocyte by the LG6.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Osborn JJ, Popper RW, Kerth WJ, Gerbode F. Respiratory insufficiency following open-heart surgery. Ann Surg 1962; 156: 638–47.
Tilney NY, Hester WJ. Physiologic and histologic changes in the lungs of patients dying after prolonged cardiopulmonary bypass. Ann Surg 1967; 166: 759–66.
Miller DR, Kuenzig MC. Pulmonary changes following normothermic and profound hypothermicperfusion in dog. J Thorac Cardiovasc Surg 1968; 56: 717–31.
Hashimoto K, Miyamoto H, Suzuki K, Horikoshi S, Matsui M, Arai T, et al. Evidence of organ damage after cardiopulmonary bypass: the role of elastase and vasoactive mediators. J Thorac Cardiovasc Surg 1992; 104: 666–73.
Kirklin JK, Blackstone EH, Kirklin JW. Cardiopulmonary bypass: studies on its damaging effects. Blood Purification 1987; 5: 168–78.
Dickstein RA. Reperfusion injury: the role of leukocytes. Perfusion Life 1990: 34–8.
Yoshida S, Higashiue S, Naitou Y. Kinetics of granulocyte and organ failure in open-heart surgery (Eng abstr). J Jpn Assn Thorac Surg 1992; 40: 1445.
Miyamoto Y. Clinical study of complement activation during cardiopulmonary bypass: analyses of complement activation pathway and transpulmonary leukosequenstration (Eng abstr). J Jpn Assn Thorac Surg 1986; 34: 2055–61.
Bando K, Pillai R, Cameron DE, Brawn JD, Winkelstein JA, Hutchins GM, et al. Leucocyte depletion ameliorates free radical mediated lung injury after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1990; 99: 873–7.
Allen SM, Pagano D, Bonser RS. Preliminary clinical evaluation of the Pall Leuko Guard (LG6) leukocyte depletion filter. Scandinavian Society for Extracorporeal Technology, 42nd Meeting Abstracts. 1993; 86: 58.
Palanzo DA, Manley NJ, Montesano RM. Clinical evaluation of the Leuko Guard (LG6) arterial line filter for routine open-heart surgery. Perfusion 1993; 8: 489–96.
Gourlay T, Fleming J, Taylor KM. Laboratory evaluation of the Pall LG6 leukocyte depleting arterial line filter. Perfusion 1992; 7: 131–40.
Meisuria N, Gourlay T, Fleming J, Taylor KM. Evaluation of the new Pall Leuko Guard6 (LG6) leukocyte depleting arterial line filter. Scandinavian Society for Extracorporeal Technology 42nd Meeting Abstracts. 1993; 87: 59.
Menasche P, Peynet J, Haeffner-Cavaillon N, Carreno MP, de Chaumaray T, Dillisse V, et al. Influence of temperature on neutrophil trafficking during clinical cardiopulmonary bypass. Circulation 1995; 92 (Suppl 9) II: 334–40.
Le Deist F, Menasche P, Kucharski C, Bel A, Piwnica A, Bloch G. Hypothermia during cardiopulmonary bypass delays but does not prevent neutrophil-endothelial cell adhesion: a clinical study. Circulation 1995; 92 (Suppl 9) II: 354–8.
Thurlow PJ, Doolan L, Sharp R, et al. Studies of the effect of Pall leucocyte filters LG6 and AV6 in an in vitro simulated extracorporeal circulatory system. Perfusion 1995; 10: 291–300.
Ebrahim K, Shafei H. Our experience with using the pall LG6 leucocyte depleting filter during cardiopul-monary bypass. Ann Thorac Surg 1993; 56: 1216–7.
Perlmutter DH, Pierce JA. The α-1-antitrypsin gene and emphysema. Am J Physiol 1989; 257: 147–62.
Banda MJ, Rice AG, Griffin GL, et al. The inhibitor complex of human α-1-protease inhibitor and human leukocyte elastase is a neutrophil chemoattractant. J Exp Med 1988; 167: 1608–15.
Ogawa M. Neutrophil elastase as a chemical mediator of organ failure (Eng abstr). Kyukyuigaku 1989; 13: 945–56.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ohto, T., Yamamoto, F. & Nakajima, N. Evaluation of leukocyte-reducing arterial line filter (LG6) for postoperative lung function, using cardiopulmonary bypass. Jpn J Thorac Caridovasc Surg 48, 295–300 (2000). https://doi.org/10.1007/BF03218142
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03218142