Abstract
OBJECTIVE:
A randomised clinical trial sought evidence as to whether leucocyte depleting arterial line
filters had any effect on intra- operative cerebral microemboli and post- operative
neuropsychological outcome in non emergency patients undergoing coronary artery
bypass (CABG) surgery.
METHODS:
One hundred and ninety -two patients were randomised to the use of a Pall LG -6
leucocyte depleting (test) filter or either an Avecor Affinity or Pall AV -6 control filter.
Cerebral microemboli during surgery were recorded by transcranial Doppler monitor
over the right middle cerebral artery. Evidence of cerebral impairment was obtained by
comparing patients' performance in a neuropsychological test battery (9 tests)
administered 6 -8 weeks post-operatively with their pre-operative scores.
RESULTS:
The groups proved well balanced in pre- operative variables. During cardiopulmonary
bypass the median number and range of microemboli was 15 (3 -180) in the leucocyte
depleting group compared to 67 (5 -846) and 55 (2 -773) for the Avecor and AV6 groups
respectively (p <0.0001). One hundred and sixty -one patients completed all the
neuropsychological tests. The leucocyte depleting group showed better post- operative
performance in all but one of the nine tests although the difference in a total change score
did not reach significance (p = 0.07, 1 tailed t test).
CONCLUSION:
Leucocyte depleting filtration during CABG reduced the number of cerebral microemboli
recorded by transcranial Doppler and showed a strong trend towards improving
neuropsychological performance post -operatively. These findings suggest that the use of
such filters in CABG surgery may offer increased neuroprotection.
