Cardiopulmonary bypass technologies - Biomaterials and Devices for the Circulatory System - page 150

Intraoperative
auto
transfusion Allogeneic

Leukocyte
reduction
transfusion
filter

Car diople gia

CPS02

Venous

Arterial

Venous
reservoir

O 2

6.6 Total leukocyte control procedure.

three groups of different pre-operative risk cohorts. No difference could be
found in low risk group. However, as the risk increased, initially biochemical
and haematologic parameters became signifi cantly better and fi nally clinical
outcome turned out to be extensively good in fi ltered groups (Table 6.3).
Cell counts on fi lter mesh were signifi cantly higher in high risk cohort.
Phagocytic capacity increased on fi lter mesh especially in high risk speci-
mens (Fig. 6.7). Scanning electron microscopy demonstrated signifi cant cap-
turing activity of leukocyte fi lters (Fig. 6.8).
Although our patient population for each risk cohort was small, the
mortality and morbidity rates were comparable with original Euroscore
evaluation. 25 The most important data in our study was that prefi ltration
quantity of CD11b up-regulation was found to be signifi cantly higher in
high risk group with respect to medium or low risk groups (Fig. 6.9). Even
before the operation the infl ammatory status of high risk patients was worse
than medium risk patients. That may help explaining the increased effi cacy
of fi lters in high risk patients.
The body of evidence supporting the application of leukocyte depletion
during CPB is substantial and continues to grow. However, more work is
required to investigate the most appropriate leukocyte depletion strategy
for both routine and high risk patients. This important clinical work is
ongoing, and recent studies have suggested that there is a synergistic
effect from combining the range of available anti-infl ammatory technolo-
gies, including leukocyte depleting fi lters, during cardiopulmonary

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