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    Clinical efficacy of two-phase leukocyte filtration in high-risk patients undergoing coronary revascularization with cardiopulmonary bypass
    (2009) Günaydın, Serdar; Modine, Thomas; Sarı, Tamer; Zorlutuna, Yaman; Gourlay, Terence
    The purpose of this study was to investigate the clinical outcome, inflammatory response and myocardial function in high-risk patients undergoing three different leukocyte depletion strategies. Over a four-month period, forty patients (EuroSCORE 6+) undergoing coronary revascularization were prospectively randomized to one of the four perfusion protocols: Group 1 (N = 10): Conventional circuits (ECC) + two leukocyte filters (LG6B, Pall, USA) with the method of two-phase (continuous + strategic) leukofiltration; Group 2 (N = 10): ECC + single leukocyte filter with the method of continuous leukofiltration; Group 3 (N = 10): ECC + single leukocyte filter with the method of strategic leukofiltration; Group 4 (N = 10) Control: ECC without leukocyte filtration. Blood samples were collected at T1: Baseline, T2: On CPB, T3: X-Clamp, T4: Off CPB, T5: ICU24 and T6: ICU48. Perioperative follow-up was thoroughly monitored. Leukocyte counts in double filter and strategic filtration groups demonstrated significant differences at T4 ( p < .05 vs. control). TNF-alpha levels were significantly lower in Group 1 at T4 and procalcitonin levels at T5 and T6 ( p < .05 vs. control). CKMB levels demonstrated well preserved myocardium in double filter group ( p < .05 vs. control). Brain natriuretic peptide levels in double filter group were significantly lower at T5 and T6 with respect to Group 2 ( p < .05) and control ( p < .001). Matrixmetallopeptidase 9 and D-Dimer levels in double filter group were significantly lower at T5 and T6 ( p < .05 vs. control). Two-phase leukofiltration is associated with some compound benefit over continuous deployment in high-risk patients. A larger more powerful study than this pilot one is warranted for further evaluation.
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    Novel Ultrafiltration Technique for Blood Conservation in Cardiac Operations
    (Elsevier Science Inc, 2013) Gunaydin, Serdar; Gourlay, Terence
    Purpose. The performance characteristics and clinical outcome of a novel hemoconcentrator, the HemoSep (Brightwake, Nottingham, United Kingdom), for reusing salvaged blood postoperatively were evaluated. Description. HemoSep concentrates blood by removing the fluid component from a pooled volume of blood salvaged at the end of the operation from the heart-lung machine. During a 6-month period, 102 patients were prospectively randomized into two groups. In group 1 (n = 52), salvaged blood in the venous reservoir after the cessation of cardiopulmonary bypass was reused by the HemoSep device and the processed blood was retransfused to the patients. In group 2 (n = 50), the control group, the operation proceeded using conventional method without using the hemoconcentrator. Evaluation. The mean amount of processed blood was 775 +/- 125 mL. The efficacy of the HemoSep device was confirmed by the percentage concentration of the hematocrit at 15 and 40 minutes. Serum albumin and factor VII levels were concentrated more than threefold at 40 minutes vs baseline measurements. Patients who received processed blood had significantly less need for an allogeneic transfusion. Conclusions. The HemoSep device functions as designed and without technical failures, offering a complementary technique in blood management during cardiac operations. (C) 2013 by The Society of Thoracic Surgeons
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    STS blood conservation guidelines: The role of leukocyte filtration
    (Elsevier Science Inc, 2008) Gourlay, Terence; Olivencia-Yurvati, Albert H.; Gunaydin, Serdar
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