Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

Abstract

By reason of surgical demand, the majority of cardiovascular procedures still depend on the use of cardiopulmonary bypass (CPB). Due to the nonphysiological state of CPB, it can cause complex and unpredictable inflammatory response, which may lead to significant morbidity and mortality. Unfortunately, the pharmacological and mechanical strategies that currently exist do not offer significant advantages in controlling inflammatory response and improving patient outcomes. The best strategy to reduce inflammation in CPB is still uncertain. In recent years, adsorptive blood purification techniques (BPTs) have emerged, among which CytoSorb is the latest representative device. Currently, the primary application area of adsorptive BPTs is in the control and treatment of systemic hyperinflammatory states, such as refractory septic shock patients. However, the evidences on efficacy and safety of adsorptive BPTs application during CPB surgery are still inconclusive, so we summarize the relevant evidences here and suggest future potential research areas.

The role of hemoadsorption in cardiac surgery – a systematic review

“…A meta-analysis from Heymann et al (69), however, showed that in fact, the use of CytoSorb ® might increase mortality in critically ill patients with inflammatory conditions, although the authors did acknowledge the low certainty of the evidence, primarily due to the lack of power to independently assess mortality across the vasty heterogeneous populations included. Interestingly, in a subgroup analysis of complex cardiac surgery, increased mortality associated with CytoSorb  was not found, which is in agreement with the findings of Naruka et al (68) and Liu et al, (2) as well as with the current systematic review. In general, leading experts in intensive care medicine are increasingly calling for new realistic clinical endpoints instead of mortality for the assessment of potential clinical benefits of novel therapies in critical patients.…”

“…The authors' conclusions that hemoadsorption devices are likely to be more beneficial in patients with higher inflammatory responses, such as infective endocarditis and emergency operations, align with the findings of the current systematic review. Furthermore, Liu et al (2) in their narrative review concluded that although data on the use of hemoadsorption in cardiac surgery is scarce and even controversial, there is no denying that adsorptive extracorporeal blood purification technology, especially CytoSorb  , opens a new door for the ongoing efforts in battling CPB-associated SIRS. A meta-analysis from Heymann et al (69), however, showed that in fact, the use of CytoSorb ® might increase mortality in critically ill patients with inflammatory conditions, although the authors did acknowledge the low certainty of the evidence, primarily due to the lack of power to independently assess mortality across the vasty heterogeneous populations included.…”

“…Extracorporeal blood purification techniques have been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications (2). This review aims to critically assess the role of hemoadsorption in cardiac surgery, by summarizing the results of published studies conducted in this clinical setting in the last decade.…”

The role of hemoadsorption in cardiac surgery – a systematic review

“…Moreover, the complexity of cardiac surgery will further increase due to the aging population, frailty, and many comorbidities. Despite recent advantages in myocardial protection for several hours, systemic pathological inflammation derived from extracorporeal circulation might still occur [ 2 ].…”

“…Extracorporeal blood purification techniques have been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications [ 2 ].…”