Leukocyte depletion at reperfusion may have a role in myocardial protection when combined with terminal
cardioplegia. We applied this method in a selected group of 68 patients with
coronary artery bypass grafting either for
elective surgical procedures (n = 38) or emergency
surgical procedures with the use of a preoperative intraaortic balloon pump (
n = 30) because of developing acute
myocardial infarction. Basic cold
potassium crystalloid cardioplegic solution was used. During delivery of leukocyte-depleted terminal
cardioplegic solution, warm arterial blood delivered from
cardiopulmonary bypass was passed through a leukocyte removal filter, mixed with
potassium crystalloid cardioplegic solution, and administered to the aortic root for the first 10 minutes of reperfusion. Patients were randomized into three groups for reperfusion: whole blood, terminal
cardioplegic solution, and leukocyte-depleted terminal
cardioplegic solution reperfusion groups. In elective
coronary artery bypass grafting, no significant difference was found in the clinical data. However, in emergency
coronary artery bypass grafting, the leukocyte-depleted terminal
cardioplegic solution group (n = 10) showed significantly lower peak
creatine kinase MB levels (leukocyte-depleted terminal
cardioplegic solution versus terminal
cardioplegic solution versus whole blood: 27 +/- 11, 56 +/- 13, 74 +/- 18, respectively; p < 0.05) and maximum
dopamine doses required at the weaning of
cardiopulmonary bypass (6.3 +/- 1.1 versus 11.2 +/- 3.3 versus 9.2 +/- 2.2; p < 0.05) than did the terminal
cardioplegic solution (n = 10) and whole
blood groups (n = 10). Moreover, the leukocyte-depleted terminal
cardioplegic solution group showed significantly lower difference of
malondialdehyde between arterial and coronary sinus blood (0.15 +/- 0.09 versus 0.36 +/- 0.06 versus 0.06 +/- 0.12 nmol/ml, p < 0.05) than did the terminal
cardioplegic solution or whole
blood groups. These results showed that leukocyte-depleted terminal blood
cardioplegic solution may have a role in attenuating
reperfusion injury in patients with critical conditions such as preoperative myocardial ischemic injury.