Effect of leukocyte-depleted blood cardioplegia on the early outcome in patients with preserved left ventricular function undergoing surgical revascularisation.

BACKGROUND: It has been shown that leukocytes play one of the key roles in the myocardial reperfusion injury. AIM: To examine the effects of cardiac protection with leukocyte-depleted blood cardioplegia on the early outcome of patients with preserved left ventricular function who undergo surgical revascularisation. METHODS: The study group consisted of 58 patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) who were randomised to receive leukocyte-depleted blood cardioplegia (leukocyte filter Pall BC1B) (group A, n=29) or to receive standard blood cardioplegia (group B, n=29). Peri-operative mortality and morbidity as well as haemodynamical and biochemical parameters were compared between these two groups. RESULTS: No early death occurred. There were no statistical differences in clinical data between the groups. Only cardiac index measured 24 hours after declamping of aorta was significantly higher in group A than in group B (3.6+/-0.6 l/min/m(2) vs 2.95+/-0.45 l/min/m(2), p<0.05). Group B showed significant higher release of creatine kinase (CK) 6 and 12 hours, and CK-MB 6, 12, and 24 hours after unclumping the aorta whereas troponin I level was similar in both groups. CONCLUSIONS: The use of leukocyte-depleted blood cardioplegia during elective CABG did not improve the early outcome.

[Acute normovolemic hemodilution together with aprotinin applied as a scheme of blood saving in cardiac surgery]. / Ostra normowolemiczna hemodylucja w polaczeniu z podawaniem aprotyniny jako schemat oszczedzania krwi w kardiochirurgii.

The risk of blood loss in open heart surgery procedures is related to a high level of homologous blood transfusion. Due to numerous possible complications connected with transfusion, as well as the increase in prices of blood preparations, methods of blood saving are of great interest. The aim of the study was to assess acute normovolemic hemo-dilution (ANH) efficacy and aprotinin administration in homologous blood usage limitations. The study was conducted in the group of 265 patients operated on during the period of 12 months. The control group consisted of patients operated on during the period 6 months. The scheme of ANH with the administration of aprotinin was applied in the second half-year period. A statistically significant reduction in the percentage of patients who required blood transfusions was observed (77.2%/53%). The scheme applied enabled to reduce procedure costs in regard to blood preparation purchase. The results have shown that ANH together with antifibrinolytic drug administration is not only an efficient but also profitable strategy of blood saving.