Effect of Leucocyte-depleted Blood Cardioplegia on Myocardial Protection in Adult Patients Underwent Cardiac Surgery: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YANGTong , ZHANGYong-qiang ,  WANGJiang , ZHENGHong , GUOHai

Department of Anesthesiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

WANGJiang, Email: 710985359@qq.com

Keywords：

Leucocyte-depleted blood cardioplegia; Myocardial preservation; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160084

Video：

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Objective To systematically evaluate the effect of leucocyte-depleted blood cardioplegia on myocardial protection in adult patients underwent cardiac surgery with extracorporeal circulation. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 2, 2015), CBM, VIP, WanFang Data and CNKI databases from inception to March 1st 2015, to collect randomized controlled trials (RCTs) about leucocyte-depleted blood cardioplegia for adult patients underwent cardiac surgery. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. Results A total of 17 RCTs including 637 patients were included. The results of meta-analysis showed that: Compared with the control group, the leucocyte-depleted blood cardioplegia could significantly reduce the level of postoperative CK-MB peak value (SMD=-0.75, 95%CI -1.12 to -0.39, P<0.0001), the utilization of inotropic drugs after operation (OR=0.51, 95%CI 0.29 to 0.92, P=0.02), and perioperative incidence of arrhythmia (OR=0.51, 95%CI 0.31 to 0.84, P=0.009). However, no significant differences were found in the incidence of perioperative myocardial infarction (OR=1.0, 95%CI 0.20 to 5.13, P=1.00), peri-operative mortality (peto-OR=0.51, 95%CI 0.05 to 4.94, P=0.56) and ICU stay (SMD=-0.06, 95%CI -0.32 to 0.21, P=0.68) between the two groups. Conclusion Current evidence shows, leucocyte-depleted blood cardioplegia could effectively reduce the myocardial injury in adult patients underwent cardiac surgery with extracorporeal circulation, but in reducing perioperative severe complications and mortality, improving the long-term prognosis in patients, the protective effect of leucocyte-depleted blood cardioplegia is yet to be evaluated. In addition, due to the limitation of quality and quantity of included studies, the above conclusion still need to be verified by conducting larger sample, high quality, multi-central RCTs.

Citation： YANGTong, ZHANGYong-qiang, WANGJiang, ZHENGHong, GUOHai. Effect of Leucocyte-depleted Blood Cardioplegia on Myocardial Protection in Adult Patients Underwent Cardiac Surgery: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(5): 543-549. doi: 10.7507/1672-2531.20160084 Copy

1.	Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3(2): 129-140.
2.	Wan S, DeSmet JM, Barvais L, et al. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1996, 112(3): 806-811.
3.	Hoffman JW Jr, Gilbert TB, Poston RS, et al. Myocardial reperfusion injury: etiology, mechanisms, and therapies. J Extra Corpor Technol, 2004, 36(4): 391-411.
4.	Warren O, Alexiou C, Massey R, et al. The effects of various leukocyte filtration strategies in cardiac surgery. Eur J Cardiothorac Surg, 2007, 31(4): 665-676.
5.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org.
6.	Browning PG, Pullan M, Jackson M, et al. Leucocyte-depleted cardioplegia does not reduce reperfusion injury in hypothermic coronary artery bypass surgery. Perfusion, 1999, 14(5): 371-377.
7.	Hayashi Y, Sawa Y, Fukuyama N, et al. Leukocyte-depleted terminal blood cardioplegia provides superior myocardial protective effects in associationwith myocardium-derived nitric oxide and peroxynitrite production for patients undergoing prolonged aorticcrossclamping for more than 120 minutes. J Thorac Cardiovasc Surg, 2003, 126(6): 1813-1821.
8.	Hiramatsu Y, Koishizawa T, Matsuzaki K, et al. Leukocyte-depleted blood cardioplegia reduces cardiac troponin T release in patients undergoing coronary arterybypass grafting. Jpn J Thorac Cardiovasc Surg, 2000, 48(10): 625-631.
9.	Ichihara T, Yasuura K, Maseki T, et al. The effects of using a leukocyte removal filter during cold blood cardioplegia. Surg Today, 1994, 24(11): 966-972.
10.	Onorati F, Santini F, Menon T, et al. Leukocyte filtration of blood cardioplegia attenuates myocardial damage and inflammation. Eur J Cardiothorac Surg, 2013, 43(1): 81-89.
11.	Ozkara C, Guler N, Kutay V, et al. Leucocyte-depleted blood cardioplegia. J Int Med Res, 2007, 35(2): 188-200.
12.	Pala MG, Paolini G, Paroni R, et al. Myocardial protection with and without leukocyte depletion: a comparative study on the oxidative stress. Eur J Cardiothorac Surg, 1995, 9(12): 701-706.
13.	Palatianos GM, Balentine G, Papadakis EG, et al. Neutrophil depletion reduces myocardial reperfusion morbidity. Ann Thorac Surg, 2004, 77(3): 956-961.
14.	Roth M, Kraus B, Scheffold T, et al. The effect of leukocyte-depleted blood cardioplegia in patients with severe left ventricular dysfunction: arandomized, double-blind study. J Thorac Cardiovasc Surg, 2000, 120(4): 642-650.
15.	Rubino AS, Serraino GF, Mariscalco G, et al. Leukocyte depletion during extracorporeal circulation allows better organ protection but does not changehospital outcomes. Ann Thorac Surg, 2011, 91(2): 534-540.
16.	Samankatiwat P, Samartzis I, Lertsithichai P, et al. Leucocyte depletion in cardiopulmonary bypass: a comparison of four strategies. Perfusion, 2003, 18(2): 95-105.
17.	Sawa Y, Taniguchi K, Kadoba K, et al. Leukocyte depletion attenuates reperfusion injury in patients with left ventricular hypertrophy. Circulation, 1996, 93(9): 1640-1646.
18.	Suzuki I, Ogoshi N, Chiba M, et al. Clinical evaluation of a leucocyte-depleting blood cardioplegia filter (BC1B) for elective open-heart surgery. Perfusion, 1998, 13(3): 205-210.
19.	De Vecchi E, Paroni R, Pala MG, et al. Role of leucocytes in free radical production during myocardial revascularisation. Heart, 1997, 77(5): 449-455.
20.	Zahler S, Massoudy P, Hartl H, et al. Acute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass. Cardiovasc Res, 1999, 41(3): 722-730.
21.	Matheis G, Scholz M, Simon A, et al. Timing of leukocyte filtration during cardiopulmonary bypass. Perfusion, 2001, 16 Suppl: 31-37.
22.	Fabbri A, Manfredi J, Piccin C, et al. Systemic leukocyte filtration during cardiopulmonary bypass. Perfusion, 2001, 16 Suppl: 11-18.
23.	Munsch C. Blood cardioplegia. Perfusion, 1991, 6(4): 245-252.
24.	Martin J, Krause M, Benk C, et al. Blood cardioplegia filtration. Perfusion, 2003, 18 Suppl1: 75-80.
25.	Blacher C, Neumann J, Jung LA, et al. Off-pump coronary artery bypass grafting does not reduce lymphocyte activation. Int J Cardiol, 2005, 101(3): 473-479.

1. Day JR, Taylor KM. The systemic inflammatory response syndrome and cardiopulmonary bypass. Int J Surg, 2005, 3(2): 129-140.
2. Wan S, DeSmet JM, Barvais L, et al. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1996, 112(3): 806-811.
3. Hoffman JW Jr, Gilbert TB, Poston RS, et al. Myocardial reperfusion injury: etiology, mechanisms, and therapies. J Extra Corpor Technol, 2004, 36(4): 391-411.
4. Warren O, Alexiou C, Massey R, et al. The effects of various leukocyte filtration strategies in cardiac surgery. Eur J Cardiothorac Surg, 2007, 31(4): 665-676.
5. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org.
6. Browning PG, Pullan M, Jackson M, et al. Leucocyte-depleted cardioplegia does not reduce reperfusion injury in hypothermic coronary artery bypass surgery. Perfusion, 1999, 14(5): 371-377.
7. Hayashi Y, Sawa Y, Fukuyama N, et al. Leukocyte-depleted terminal blood cardioplegia provides superior myocardial protective effects in associationwith myocardium-derived nitric oxide and peroxynitrite production for patients undergoing prolonged aorticcrossclamping for more than 120 minutes. J Thorac Cardiovasc Surg, 2003, 126(6): 1813-1821.
8. Hiramatsu Y, Koishizawa T, Matsuzaki K, et al. Leukocyte-depleted blood cardioplegia reduces cardiac troponin T release in patients undergoing coronary arterybypass grafting. Jpn J Thorac Cardiovasc Surg, 2000, 48(10): 625-631.
9. Ichihara T, Yasuura K, Maseki T, et al. The effects of using a leukocyte removal filter during cold blood cardioplegia. Surg Today, 1994, 24(11): 966-972.
10. Onorati F, Santini F, Menon T, et al. Leukocyte filtration of blood cardioplegia attenuates myocardial damage and inflammation. Eur J Cardiothorac Surg, 2013, 43(1): 81-89.
11. Ozkara C, Guler N, Kutay V, et al. Leucocyte-depleted blood cardioplegia. J Int Med Res, 2007, 35(2): 188-200.
12. Pala MG, Paolini G, Paroni R, et al. Myocardial protection with and without leukocyte depletion: a comparative study on the oxidative stress. Eur J Cardiothorac Surg, 1995, 9(12): 701-706.
13. Palatianos GM, Balentine G, Papadakis EG, et al. Neutrophil depletion reduces myocardial reperfusion morbidity. Ann Thorac Surg, 2004, 77(3): 956-961.
14. Roth M, Kraus B, Scheffold T, et al. The effect of leukocyte-depleted blood cardioplegia in patients with severe left ventricular dysfunction: arandomized, double-blind study. J Thorac Cardiovasc Surg, 2000, 120(4): 642-650.
15. Rubino AS, Serraino GF, Mariscalco G, et al. Leukocyte depletion during extracorporeal circulation allows better organ protection but does not changehospital outcomes. Ann Thorac Surg, 2011, 91(2): 534-540.
16. Samankatiwat P, Samartzis I, Lertsithichai P, et al. Leucocyte depletion in cardiopulmonary bypass: a comparison of four strategies. Perfusion, 2003, 18(2): 95-105.
17. Sawa Y, Taniguchi K, Kadoba K, et al. Leukocyte depletion attenuates reperfusion injury in patients with left ventricular hypertrophy. Circulation, 1996, 93(9): 1640-1646.
18. Suzuki I, Ogoshi N, Chiba M, et al. Clinical evaluation of a leucocyte-depleting blood cardioplegia filter (BC1B) for elective open-heart surgery. Perfusion, 1998, 13(3): 205-210.
19. De Vecchi E, Paroni R, Pala MG, et al. Role of leucocytes in free radical production during myocardial revascularisation. Heart, 1997, 77(5): 449-455.
20. Zahler S, Massoudy P, Hartl H, et al. Acute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass. Cardiovasc Res, 1999, 41(3): 722-730.
21. Matheis G, Scholz M, Simon A, et al. Timing of leukocyte filtration during cardiopulmonary bypass. Perfusion, 2001, 16 Suppl: 31-37.
22. Fabbri A, Manfredi J, Piccin C, et al. Systemic leukocyte filtration during cardiopulmonary bypass. Perfusion, 2001, 16 Suppl: 11-18.
23. Munsch C. Blood cardioplegia. Perfusion, 1991, 6(4): 245-252.
24. Martin J, Krause M, Benk C, et al. Blood cardioplegia filtration. Perfusion, 2003, 18 Suppl1: 75-80.
25. Blacher C, Neumann J, Jung LA, et al. Off-pump coronary artery bypass grafting does not reduce lymphocyte activation. Int J Cardiol, 2005, 101(3): 473-479.

Chinese Journal of Evidence-Based Medicine

Effect of Leucocyte-depleted Blood Cardioplegia on Myocardial Protection in Adult Patients Underwent Cardiac Surgery: A Meta-analysis

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