Does leukofiltration reduce pulmonary infections in CABG patients? A prospective, randomized study with early results and mid-term survival

Background— We present the first prospective randomized study of primary coronary artery bypass grafting (CABG) patients who were analyzed for postoperative infections after undergoing blood and/or blood product transfusion (BBPT) with a Pall Purecell leukoreducing filter.Methods and results— One hundred and four patients were enrolled between March 1998 and March 1999. Seventy-two of the patients received BBPT (average 5.6 units BBPT/filter patient and 5.6 units/control patient). Three patients who had CABG without extracorporeal circulation or mixed transfusions of filtered and unfiltered BBPT were excluded. The remaining 69 transfused patients (38 filtered, 31 control) were analyzed and the incidence of culture proven infections was recorded. Mid-term survival data were obtained from the National Death Index and Kaplan-Meier survival plots were constructed. All patients were stratified and matched according to the EuroSCORE. Thirty-day mortality was 2.6% and 3.2% for the filtered and control patients, respectively. There were 5 cases of culture proven infections in 38 filtered patients (13.2%) and 8 in 31 controls (25.8%), P=0.224. No pulmonary tract infections were recorded in the filter group vs. 4 (12.9%) in controls, P=0.048. Reduced length for mechanical ventilation (16.3 hours vs. 57.8, P=0.103), length of stay (9.1 vs. 10.8 days, P=0.685), as well as increased 50-month actuarial survival, (45.5 vs. 42.3 months, P=0.695) in filtered vs. control, respectively, were recorded.Conclusions— The use of leukoreduced BBPT reduced the incidence of pulmonary tract infections in patients undergoing CABG.