Efficacy of Hemoperfusion Cartridge Procedure on Patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass

Efficacy of Hemoperfusion in Cardiac Valve Replacement Surgery with CPB

Authors

  • Ke Yang Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Honghao Huang Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Ruiwu Dai College of Medicine, Southwest Jiaotong University, Chengdu, China
  • Siyi He Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Jinbao Zhang Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Fan Wu Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Xiaohong Wei Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Feng Gao Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Xiaochen Wu Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China
  • Mei Xin Department of Cardiovascular Surgery, General Hospital of Western Theater Command, Chengdu, China

DOI:

https://doi.org/10.1532/hsf.5213

Keywords:

hemoperfusion cartridge, inflammatory response, cardiopulmonary bypass, cardiac surgery, cardiac valve replacement surgery

Abstract

Objectives: Cardiopulmonary bypass (CPB) induces inflammatory homeostasis dysregulation, closely related to many postoperative adverse effects. Minimizing the systemic inflammatory response to CPB is imperative to improving cardiac surgery safety. This study aimed to retrospectively evaluate the efficacy of the hemoperfusion cartridge, a device recently designed for extracorporeal blood purification to remove cytokines from the blood for patients undergoing cardiac valve replacement surgery using CPB.

Methods: The hemoperfusion (HP) group consisted of 138 patients, who underwent a hemoperfusion cartridge procedure during CPB. The control group included 149 patients, who received standard CPB management. The evaluated indices included inflammatory cytokines, blood biochemical indices, and postoperative outcome indices.

Results: Patients in the HP group had relatively lower interleukin (IL)-6 levels (days one and two post-CPB) and IL-8 (day one post-CPB) compared with the control group. Some relatively decreased biochemical blood indices also were observed in the HP group, including a significantly lower lactic acid level (days one, two, and three post-CPB), platelet counts (days one, two, and three post-CPB), and aspartate aminotransferase (days one and three post-CPB). Regarding the postoperative outcomes, no severe complications occurred in the patients; however, the HP group required less ventilation time than the control group.

Conclusions: The hemoperfusion cartridge seems promising in limiting the inflammatory reactions during CPB, with noteworthy potential for application in cardiac surgery.

References

Bauer A, et al. 2018. Shed-blood-separation and cell-saver: an integral part of MiECC? Shed-blood-separation and its influence on the perioperative inflammatory response during coronary revascularization with minimal invasive extracorporeal circulation systems–a randomized controlled trial. Perfusion. 33(2): p. 136-147.

Bernardi MH, et al. 2016. Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using a novel adsorbent. Crit Care. 20(1): p. 96.

Bojan M. 2019. Recent achievements and future developments in neonatal cardiopulmonary bypass. Pediatr Anesth. 29(5): p. 414-425.

Bonavia A, et al. 2018. Clinical utility of extracorporeal cytokine hemoadsorption therapy: a literature review. Blood purificat. 46(4): p. 337-349.

Bronicki RA, Hall M. 2016. Cardiopulmonary bypass-induced inflammatory response: pathophysiology and treatment. Peditr Crit Care Me. 17(8): p. S272-S278.

Cardoso TAAM, et al. 2021. Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial. Trials. 22(1): p. 25.

De Rosa S, Villa G, Ronco C. 2020. The golden hour of polymyxin B hemoperfusion in endotoxic shock: the basis for sequential extracorporeal therapy in sepsis. Artif Organs. 44(2): p. 184-186.

Delannoy B, et al. 2009. Effect of cardiopulmonary bypass on activated partial thromboplastin time waveform analysis, serum procalcitonin and C-reactive protein concentrations. Crit Care. 13: p. R180.

Diab M, et al. 2022. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation. 145(13): p. 959-968.

Evora PRB, et al. 2016. Key points for curbing cardiopulmonary bypass inflammation. Acta Cir Bras. 31: p. 45-52.

Gorjipour F, et al. 2017. Inflammatory cytokine response and cardiac troponin I changes in cardiopulmonary bypass using two cardioplegia solutions; del Nido and modified St. Thomas’: a randomized controlled trial. Perfusion. 32(5): p. 394-402.

He Z, et al. 2022. The efficacy of resin hemoperfusion cartridge on inflammatory responses during adult cardiopulmonary bypass. Blood Purificat. 51(1): p. 31-37.

Houschyar KS, et al. 2017. Continuous hemoadsorption with a cytokine adsorber during sepsis–a review of the literature. Int J Artif Organs. 40(5): p. 205-211.

Iannaccone G, et al. 2020. Weathering the cytokine storm in COVID-19: therapeutic implications. Cardiorenal Med. 10(5): p. 277-287.

Jenke A, et al. 2021. AdipoRon Attenuates Inflammation and Impairment of Cardiac Function Associated With Cardiopulmonary Bypass–Induced Systemic Inflammatory Response Syndrome. J Am Heart Assoc. 10(6): p. e018097.

Landis RC, et al. 2014. Attenuating the systemic inflammatory response to adult cardiopulmonary bypass: a critical review of the evidence base. J Extra Corpor Technol. 46(3): p. 197.

Lomivorotov V, et al. 2020. Effect of intraoperative dexamethasone on major complications and mortality among infants undergoing cardiac surgery: the decision randomized clinical trial. JAMA. 323(24): p. 2485-2492.

Missault S, et al. 2020. Analysis of clinical outcome and postoperative organ function effects in a propensity‐matched comparison between conventional and minimally invasive mitral valve surgery. J Cardiac Surg. 35(12): p. 3276-3285.

Montin DP, et al. 2018. Biocompatibility and cytotoxic evaluation of new sorbent cartridges for blood hemoperfusion. Blood Purificat. 46(3): p. 187-195.

Poli EC, et al. 2019. Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial. Crit Care. 23(1): p. 108.

Ronco C, et al. 2021. Extracorporeal blood purification and organ support in the critically ill patient during COVID-19 pandemic: expert review and recommendation. Blood purificat. 50(1): p. 17-27.

Ronco C, Bellomo R. 2022. Hemoperfusion: technical aspects and state of the art. Crit Care, 2022. 26(1): p. 135.

Saračević A, et al. 2020. The association of systemic inflammatory markers with indicators of stress and cardiac necrosis in patients undergoing aortic valve replacement and revascularization surgeries. Physiol Res. 69: p. 261-274.

Schädler D, et al. 2017. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: a randomized controlled trial. PloS one. 12(10): p. e0187015.

Stockmann H, et al. 2022. CytoSorb rescue for COVID-19 patients with vasoplegic shock and multiple organ failure: A prospective, open-label, randomized controlled pilot study. Crit Care Med. 50(6): p. 964-976.

Sun S, et al. 2015. High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis: a controlled pilot study. Ann Saudi Med. 35(5): p. 352-358.

Supady A, et al. 2021. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial. Lancet Resp Med. 9(7): p. 755-762.

Träger K, et al. 2016. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs, 2016. 39(3): p. 141-146.

Träger K, et al. 2017. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass-a case series. Int Artif Organs. 40(5): p. 240-249.

Published

2023-01-11

How to Cite

Yang, K., Huang, H., Dai, R., He, S., Zhang, J., Wu, F., Wei, X., Gao, F., Wu, X., & Xin, M. (2023). Efficacy of Hemoperfusion Cartridge Procedure on Patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass: Efficacy of Hemoperfusion in Cardiac Valve Replacement Surgery with CPB. The Heart Surgery Forum, 26(1), E020-E026. https://doi.org/10.1532/hsf.5213

Issue

Section

Articles