Which is better to preserve pulmonary function: Short-term or prolonged leukocyte depletion during cardiopulmonary bypass? Kaiyu Tao, MD, Qi An, MD,

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Which is better to preserve pulmonary function: Short-term or prolonged leukocyte depletion during cardiopulmonary bypass? Kaiyu Tao, MD, Qi An, MD, Ke Lin, MD, Raphael C. Lui, MD, FACS, Xiaodong Wu, MS, Jing Zhou, MS, Lei Du, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 6, Pages 1385-1391 (December 2009) DOI: 10.1016/j.jtcvs.2009.07.059 Copyright © 2009 Terms and Conditions

Figure 1 Mean neutrophil counts of the 3 groups. No difference of neutrophil counts was observed among the 3 groups before filtration (3 minutes of CPB). The counts were significantly lower in the LD-T and LD-S group compared with the control group (P = .003 and P = .002, respectively) at 13 minutes of CPB. The neutrophil counts in the LD-T and LD-S groups were less than in the control group until 3 hours after CPB. There was no difference between the LD-T and LD-S groups. LD-T group, The leukocyte depletion filter was used from 3 minutes to the end of CPB; LD-S group, the leukocyte depletion filter was used from 3 minutes to 13 minutes of CPB; control group, no leukocyte depletion filter was used; CPB, cardiopulmonary bypass. ∗P < .05; ∗∗P < .01 versus control. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1385-1391DOI: (10.1016/j.jtcvs.2009.07.059) Copyright © 2009 Terms and Conditions

Figure 2 The respiratory status of the 3 groups. A, The mean PVR in the LD-S group was significantly lower than that in the control group and LD-T group at the end of and 3, 6, 12, and 24 hours after CPB (P < .05, respectively), but the PVR in the LD-T group at 24 hours after CPB (P < .05) was significantly higher than that in the control group. B, Oxygen index in the LD-S group was significantly higher than that in the LD-T group at 24 hours after CPB (P = .048). LD-T group, The leukocyte depletion filter was used from 3 minutes to the end of CPB; LD-S group, the leukocyte depletion filter was used from 3 minutes to 13 minutes of CPB; control group, no leukocyte depletion filter was used; CPB, cardiopulmonary bypass; PVR, pulmonary vascular resistance; Pao2, arterial oxygen tension; Fio2, fraction of inspired oxygen. ∗P < .05 versus control group; #P < .01 versus LD-T group. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1385-1391DOI: (10.1016/j.jtcvs.2009.07.059) Copyright © 2009 Terms and Conditions

Figure 3 The plasma mediators and mediators in lung tissue of the 3 groups. A, The concentration of neutrophil elastase in the LD-T group was significantly higher than that in the control group at the end of and 3 and 6 hours after CPB (P <.01). The concentration of neutrophils elastase in the control group was significantly higher than that in the LD-S group at 3 hours (P < .01) and 6 hours (P < .01) after CPB. B, The plasma IL-8 levels in the LD-T group was significantly higher than those in the control group and LD-S group at the end of CPB (P < .01) and 3 hours (P < .01) and 6 hours (P < .01) after CPB. No difference between the control and LD-S group was noticed. C, The concentrations of MPO in the 2 depleting groups were lower than that in the control group at the end of CPB (P = .041, P = .037) and 3 hours (P < .01) and 6 hours after CPB (P < .01). The concentration of MPO in the LD-T group was significantly higher than that in the control group and LD-S group at 24 hours after CPB (P < .01). D, The concentration of IL-8 in lung tissue in the LD-S group was significantly lower than that in the control group at the end of CPB (P < .01) and 3 hours (P < .01) and 6 hours after CPB (P < .01). It was significantly lower than that in the LD-T group at the end of CPB and 3, 6, 12, and 24 hours after CPB (P < .01). LD-T group, The leukocyte depletion filter was used from 3 minutes to the end of CPB; LD-S group, the leukocyte depletion filter was used from 3 minutes to 13 minutes of CPB; control group, no leukocyte depletion filter was used; CPB, cardiopulmonary bypass; IL-8, interleukin 8; MPO, myeloperoxidase. ∗P < .05; ∗∗P < .01 versus control group; #P < .01 versus LD-T group. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1385-1391DOI: (10.1016/j.jtcvs.2009.07.059) Copyright © 2009 Terms and Conditions

Figure 4 Pathologic examination of lung tissue. A, The pulmonary tissue in the 3 groups stained with hematoxylin and eosin examined under a light microscope at ×400 magnification. B, The alveolar walls in the control group and LD-T group were significantly thicker than that in the LD-S group at 24 hours after CPB. LD-T group, The leukocyte depletion filter was used from 3 minutes to the end of CPB; LD-S group, the leukocyte depletion filter was used from 3 minutes to 13 minutes of CPB; control group, no leukocyte depletion filter was inserted in the circuit; CPB, cardiopulmonary bypass. ∗P < .001 versus control group; #P < .001versus LD-T group. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 1385-1391DOI: (10.1016/j.jtcvs.2009.07.059) Copyright © 2009 Terms and Conditions