Cardiopulmonary bypass has made modern cardiac surgery possible, but it also triggers a substantial systemic inflammatory response. When blood comes into contact with the artificial surfaces of the bypass circuit, a cascade of immune activation begins. This inflammatory reaction can contribute to postoperative organ dysfunction, hemodynamic instability, prolonged recovery, and complications involving the heart, lungs, kidneys, liver, and coagulation system. In this study, the authors investigated whether adding HA380 hemoperfusion to the cardiopulmonary bypass circuit could lessen that inflammatory burden and improve early postoperative outcomes in patients undergoing cardiac surgery.
The study enrolled 65 adults who underwent elective cardiac surgery with cardiopulmonary bypass at a single hospital between May 2022 and July 2024. Patients were randomly assigned into two groups. Thirty-four patients received standard cardiopulmonary bypass plus HA380 hemoperfusion throughout the bypass period, while 31 patients underwent conventional bypass without the adsorption cartridge. Most operations were valvular procedures, with a small number of other cardiac surgeries included. The baseline characteristics of the two groups, including age, sex, body mass index, left ventricular ejection fraction, operation time, bypass time, diabetes status, atrial fibrillation, and preoperative cardiac function, were not significantly different, which supports a fair comparison between groups.
The HA380 device is designed to adsorb medium-molecular-weight substances, especially inflammatory mediators in the approximate 0.5 to 60 kDa range. The investigators hypothesized that using HA380 during bypass would remove key inflammatory cytokines and thereby reduce the postoperative inflammatory response, stabilize circulation, and protect end organs. Their primary endpoint was postoperative IL-6 at 24 hours, while secondary endpoints included other cytokines, vasoactive drug use, liver and kidney function tests, blood counts, coagulation, ventilation time, and ICU stay.
To assess inflammation, the authors measured IL-1β, IL-6, IL-8, IL-10, TNF-α, and CRP before surgery, immediately after surgery, 24 hours after surgery, and 48 hours after surgery. The results showed a clear early anti-inflammatory signal. In the HA380 group, IL-1β, IL-6, IL-8, and IL-10 were significantly lower than in the control group immediately after surgery and again at 24 hours. By 48 hours, the differences were no longer statistically significant, suggesting that the main benefit occurred in the early postoperative phase when bypass-related inflammation is often at its peak. TNF-α and CRP did not differ significantly between the groups at any measured time point. The trend graphs in the paper show inflammatory markers rising after surgery and beginning to fall by 48 hours, with the HA380 group consistently lower for several cytokines during the early postoperative period.
The clinical findings were also notable. Patients treated with HA380 had a significantly lower 24-hour cumulative vasoactive-inotropic score, indicating less need for medications to support blood pressure and cardiac output after surgery. This suggests improved hemodynamic stability, an important practical benefit in the ICU. The HA380 group also showed lower white blood cell counts and neutrophil counts on the first postoperative day, which is consistent with a reduced inflammatory response. In addition, liver and kidney markers were better in the intervention group: alanine aminotransferase, urea, and creatinine were all significantly lower after surgery. These findings support the idea that reducing inflammation during bypass may help limit short-term organ stress or injury.
At the same time, not every outcome improved. Mechanical ventilation time, chest drainage volume, urine output, ICU length of stay, hemoglobin, platelet count, bilirubin, and coagulation indices did not differ significantly between groups. In other words, the inflammatory and laboratory improvements did not translate into shorter ICU stays or faster extubation in this relatively small trial. That is an important point for clinicians and readers interested in real-world recovery metrics. The treatment appears promising, but the measurable benefits remained mostly in biomarker reduction, vasoactive support requirements, and early organ function indicators rather than broader recovery outcomes.
The authors also reported no device-related safety concerns during surgery. There were no observed problems such as circuit obstruction, coagulation issues related to the adsorber, or clear increases in bleeding complications. Postoperative drainage and coagulation tests were similar between groups, which is reassuring for perioperative safety. That said, the follow-up period was short, limited to 48 hours for most reported outcomes, so long-term safety and durability of benefit remain uncertain.
This paper contributes to a growing body of research on hemoadsorption in cardiac surgery. Its main value is showing that HA380 may reduce the early cytokine surge associated with cardiopulmonary bypass across a mixed cardiac surgery population rather than in only one narrow procedure type. However, the study also has meaningful limitations. It was single-center, included only 65 patients, and did not appear to be blinded. The sample was too small to robustly assess harder outcomes such as mortality, major complications, acute kidney injury rates, or longer-term recovery. Most patients underwent valve surgery, so generalizability to broader cardiac surgery populations is also limited. The paper itself acknowledges the need for larger multicenter studies with longer follow-up and stronger cost-effectiveness evaluation.
Overall, this study suggests that integrating HA380 hemoperfusion into cardiopulmonary bypass may be a useful adjunct strategy for reducing early postoperative inflammation and improving short-term physiologic stability after cardiac surgery. The evidence is encouraging, especially for cytokine control and immediate postoperative support, but it is not yet definitive enough to establish routine use across all cardiac surgery settings. Larger randomized trials will be needed to determine whether these biologic and laboratory improvements produce durable clinical benefits.
