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Eur J Cardiothorac Surg 2004;25:267-274
© 2004 Elsevier Science NL

The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery

Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, 2nd Floor, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK

Received 26 November 2002; received in revised form 31 July 2003; accepted 12 November 2003.

^* Corresponding author. Tel.: +44-207-679-9476; fax: +44-207-679-9426
e-mail: s.newman{at}ucl.ac.uk

Objective: A randomised clinical trial sought evidence as to whether leucocyte-depleting (LD) arterial line filters added a further degree of neuroprotection in patients undergoing elective coronary artery bypass graft (CABG) surgery. Methods: One hundred and ninety-two patients were randomised to the use of a Pall Leukoguard-6 LD filter or either an Avecor Affinity or Pall Autovent-6 control filter. Cerebral microemboli during surgery were recorded by transcranial Doppler (TCD) monitor over the right middle cerebral artery. Evidence of cerebral impairment was obtained by comparing patients' performance in a neuropsychological (NP) test battery (nine 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 (CPB) the median number and range of microemboli was 15 (3–180) in the LD group compared to 67 (5–846) and 55 (2–773) for the Avecor and AV6 groups, respectively (P<0.0001). One hundred and sixty-two patients completed all the NP tests. The LD group showed better post-operative performance in all but one of the nine tests although the difference in a total change score just failed to reach significance (P=0.07 one-tailed t-test). Conclusions: LD filtration during CABG reduced the number of cerebral microemboli recorded by TCD and showed a strong trend towards improving NP performance post-operatively. These findings suggest that the use of such filters in CABG surgery may offer increased neuroprotection.

Key Words: Coronary artery bypass graft surgery • Neuropsychology • Leucocyte • Filters • Microemboli

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