Hemoadsorption during cardiopulmonary bypass to absorb plasma-free hemoglobin in patients with acute type a aortic dissection: A randomized controlled trial.

Abstract

Aims: This study aimed to investigate the effect of hemoadsorption (HA) on plasma-free hemoglobin (pfHb) levels during cardiopulmonary bypass (CPB) and the clinical outcomes in patients with acute type A aortic dissection (ATAAD).

Methods: In this single-center randomized trial, patients were assigned to either a group using the HA380 device or a control group without it. The primary outcome was changes in pfHb levels during CPB and within the first 48 hours after surgery. The study concentrated on comparing compared the data between the two groups using analysis of variance for repeated measures. Concurrently, both correlation and linear regression analyses were employed to identify the factors influencing pfHb levels.

Results: The mean pfHb concentration was lower in the HA380 group than in the control group,but there were no significant differences between the two groups (F = 2.883, 95% confidence interval CI: -0.006 to 0.072, p = .093) using a repeated measures analysis of covariance model. Linear regression analysis identified body mass index (BMI) as the primary factor influencing the adsorption effect (B = 0.01, 95% CI: 0.36-1.24, p = .001). Additionally, the major postoperative complications within the first 48 hours did not show significant differences between the groups, including acute kidney injury (AKI) (25% HA380 group vs 36% control group, p = .261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16% control group, p = .106).

Conclusion: The use of the HA380 device in CPB during cardiac operations may contribute to reduced pfHb levels. However, the difference was statistically non-significant because pfHb adsorption was notably influenced by the patient's BMI. Consequently, BMI should be considered when deploying HA380 in prolonged CPB procedures, including ATADD repair. Enhancing either the number of devices or the duration of HA in patients with overweight or obesity may potentially improve postoperative clinical outcomes.