Bao Yu, Wang XiaoJun, Zi YunFeng, Qian Xu, Li YongBo, Li ShuXi, Wang Zhao
Department of Cardiovascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China.
Key Laboratory of Cardiovascular Disease of Yunnan Province, China.
Perfusion. 2025 Sep;40(6):1477-1486. doi: 10.1177/02676591241305276. Epub 2024 Dec 3.
AimsThis 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).MethodsIn 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.ResultsThe mean pfHb concentration was lower in the HA380 group than in the control group,but there were no significant differences between the two groups ( = 2.883, 95% confidence interval CI: -0.006 to 0.072, = .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 ( = 0.01, 95% CI: 0.36-1.24, = .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, = .261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16% control group, = .106).ConclusionThe 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.
目的
本研究旨在探讨血液吸附（HA）对体外循环（CPB）期间血浆游离血红蛋白（pfHb）水平的影响以及对急性A型主动脉夹层（ATAAD）患者临床结局的影响。
方法
在这项单中心随机试验中，患者被分配至使用HA380装置的组或不使用该装置的对照组。主要结局是CPB期间及术后48小时内pfHb水平的变化。该研究集中于使用重复测量方差分析比较两组之间的数据。同时，采用相关性分析和线性回归分析来确定影响pfHb水平的因素。
结果
HA380组的平均pfHb浓度低于对照组，但使用重复测量协方差模型分析时两组之间无显著差异（F = 2.883，95%置信区间CI：-0.006至0.072，P = 0.093）。线性回归分析确定体重指数（BMI）是影响吸附效果的主要因素（β = 0.01，95%CI：0.36 - 1.24，P = 0.001）。此外，两组在术后48小时内的主要术后并发症无显著差异，包括急性肾损伤（AKI）（HA380组为25%，对照组为36%，P = 0.261）和术后肝功能障碍（PLD）（HA380组为5%，对照组为16%，P = 0.106）。
结论
在心脏手术的CPB期间使用HA380装置可能有助于降低pfHb水平。然而，由于pfHb吸附受患者BMI的显著影响，差异在统计学上无显著性。因此，在包括ATAAD修复在内的长时间CPB手术中部署HA380时应考虑BMI。增加超重或肥胖患者的装置数量或HA持续时间可能会潜在改善术后临床结局。
