The Effects of Packed Red Blood Cell Washing and Circuit Precirculation-Ultrafiltration on the Production of Cytokines by Open Heart Surgery

Jun, Tae Gook; Rho, Joon Ryang

Abstract

BACKGROUND: The washing of packed red blood cells could remove pro-inflammatory mediators,cell debris,and micro-particles contained in packed red blood cells,and the preci- rculation-ultrafiltration (recirculation and ultrafiltration of circuit itself before cardiopulmonary bypass)could attenuate the initial inflammatory reaction and remove the initial proinflam- mat ory medi at ors.Thi s st udy was performed t o eval uat e whet her the washing of packed red blood cells and precirculation-ultrafiltration can reduce the production of cytokines that have an important role in myocardial reperfusion injury.This study investigated the effects of washing the packed red blood cells and precirculation-ultrafiltration on the production of cytokines during and after cardiopulmonary bypass and open heart surgery. MATERIAL AND METHOD: Forty eight infants with VSD undergoing open heart surgery under cardiopulmonary bypass were randomized into control group (group C,n=12),washing group (group W,n=12), precirculation-ultrafiltration group (group F,n=12),and combined group(washing and precirculation-ultrafiltration,group WF,n=12).Blood samples were obtained before,during,and after the bypass to assess plasma level of tumor necrosis factor-alpha (TNF-alpha ),interleukin-6 (IL-6),and interleukin-8 (IL-8).
RESULTS
Expressions of TNF-alpha were significantly reduced in combined group (group WF)compared with group C,group W,and group F(p < 0.05). Expression of IL-6 were significantly reduced in group W,group F,and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.053).Expression of IL-8 were reduced in group W and group WF compared with group C (p < 0.05),but similar among group W,group F,and group WF (p=0.067).
CONCLUSION
In conclusion,the washing of packed red blood cells and precirculation-ultrafiltration blunted the increase of TNF-alpha ,IL-6,and IL-8 during and after open heart surgery with cardiopulmonary bypass.However,the clinical benefits of these treatments remains unproven.