Low density lipoprotein apheresis during cardiopulmonary bypass of hypercholesterolemic patients.

Ischemia-reperfusion injury in open heart surgery can cause atherosclerotic changes in both bypass grafts and native coronary arteries by increasing endothelial permeability and allowing excessive influx of LDL into the subendothelium. The authors used LDL apheresis during cardiopulmonary bypass (CPB) to actively remove serum LDL before reperfusion, minimizing LDL influx. They evaluated the efficacy and safety of this new procedure in eight hypercholesterolemic patients. The control group consisted of 41 patients. Mean LDL cholesterol (LDL-C) level on admission was 180 +/- 41 (SD) in the LA group and 139 +/- 32 mg/dl in the control group (p = 0.02). After 105 +/- 27 min of apheresis, the LDL-C level in the LA group decreased to 62 +/- 25 mg/dl (reduction rate: 59 +/- 18%). In contrast, in the control group, the LDL-C level was reduced to 117 +/- 41 mg/dl (reduction rate: 16 +/- 9.5% [P = 0.0001]) after CPB. No significant difference was observed in intraoperative blood loss, postoperative blood loss, platelet count, prothrombin time, activated partial thromboplastin time, incidence of wound complications, or early patency rate of bypass graft between groups. Low density lipoprotein apheresis during CPB is a safe and effective method for lowering serum LDL level sufficiently before reperfusion, and can adequately reduce LDL influx into the vessel wall.