Myocardial protection with and without leukocyte depletion: A comparative study on the oxidative stress

We tested the hypothesis that controlled reperfusion with leukocyte-depleted blood could improve myocardial protection by reducing theoxidative stress in patients undergoing myocardial revascularization.Thirty-four patients receiving antegrade/retrograde blood cardioplegia weredivided into: group A: 11 patients with ejection fractions (EF) less than35%, treated with leukocyte-depleted controlled blood reperfusion, group B:11 patients with EF less than 35% in whom no leukocyte depletion wasperformed, group C: 6 patients with EF more than 45% treated as group A andgroup D: 6 patients with EF more than 45% without leukocyte depletion. Toasses the oxidative stress, we evaluated total, total oxidized (GSSX), andreduced glutathione (GSH) in coronary sinus plasma, immediately beforecross-clamping the aorta (T0), and at 0 (T1), 15 (T2) and 30 (T3) min afterunclamping it. In groups A and B a significant shift towards oxidation ofredox status of glutathione (GSH/GSSX) at T1 vs T0 was observed.Glutathione redox ratio remained low in group B while in group A itreturned to the basal value at T2 with a significant difference from groupB at T2 and T3. No differences were observed between groups C and D. Inconclusion, our data show that leukocyte-depleted reperfusion can afford abetter myocardial protection in patients with left ventricular dysfunction, while it seems unnecessary in patients with normal EF. © 1995, Springer-Verlag.