Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

Abstract Background . Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtration by a new prototype large capacity leukocyte filter. Patients and methods . Patients undergoing cardiopulmonary bypass surgery were prospectively divided into two groups: a leukocyte removal group ( n =11) receiving leukocyte filtration during cardiopulmonary bypass and a control group ( n =20) with no filtration. The filtration efficiency was indicated by electronic leukocyte counts before and after filtration and the clinical efficiency to reduce post-operative morbidity was indicated by PaO 2 . Safety was indicated by monitoring the filtration pressure and leukocyte release products across the filter, as well as by examining the post-filtration filter by light and electron microscopy. Results . On an average, 75% of all entering leukocytes were removed by the filter. The post-operative PaO 2 showed a tendency to improve after filtration. During filtration, the pressure across the filter material increased in five cases, accompanied by an increase in post-filter plasma hemoglobin and β-glucuronidase. Within these filters accumulations of fibrin network with many trapped leukocytes were discovered microscopically. Conclusions . The filter was efficient in filtering leukocytes, but the filtration efficiency slowed at the end of filtration. Furthermore, the patients' post-operative parameters showed a tendency to improve after filtration. However, flow obstruction by means of clotting seems to be an important issue of safety involved in the filtration of large numbers of leukocytes for cardiopulmonary surgical patients.