Journal of cardiothoracic surgery · 2025
Efficacy of hemadsorption combining with cardiopulmonary bypass used in patients with acute type A aortic dissection.
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Guo Shichao, Wang Zhiyuan, Zhao Youwei, Guo Yingying, Zhang Huijun, Liu Jia
Аннотация
BACKGROUND: It is hypothesized that combining HA380 with cardiopulmonary bypass (CPB) in acute type A aortic dissection (ATAAD) surgery could reduce the inflammatory response induced by CPB and subsequently improve prognosis.? Therefore, we aimed to assess the short-term effectiveness of combining HA380 with CPB in treating ATAAD.
METHODS: This study exclusively included individuals diagnosed with ATAAD at our institution from January 2021 to April 2023. After propensity score matching (PSM), patients were allocated into two groups: the hemadsorption (HA) group (n = 45) and the control group (n = 45). The outcome measures included commonly used clinical inflammatory markers, coagulation function, liver and kidney function, ventilator time, and time of ICU stay duration.
RESULTS: Patients in the HA group exhibited elevated postoperative levels of procalcitonin and systemic coagulation-inflammation index (SCI), along with lower white blood cell counts and blood urea nitrogen levels compared to the control group. The HA group had a significantly higher 60-day postoperative survival rate compared to the control group. While the HA group experienced reduced in-hospital mortality and stroke incidence, only the reduction in stroke incidence showed a significant association with the intervention after adjusting for confounders.
CONCLUSION: The application of HA380 does not significantly reduce all postoperative inflammatory indicators in ATAAD surgery. The reduction in inflammatory response was also not obvious. However, it was associated with a significantly lower stroke incidence and improved 60-day survival, suggesting potential clinical benefits in specific outcomes. The specific mechanisms underlying the lower rates of stroke and mortality require further investigation.
METHODS: This study exclusively included individuals diagnosed with ATAAD at our institution from January 2021 to April 2023. After propensity score matching (PSM), patients were allocated into two groups: the hemadsorption (HA) group (n = 45) and the control group (n = 45). The outcome measures included commonly used clinical inflammatory markers, coagulation function, liver and kidney function, ventilator time, and time of ICU stay duration.
RESULTS: Patients in the HA group exhibited elevated postoperative levels of procalcitonin and systemic coagulation-inflammation index (SCI), along with lower white blood cell counts and blood urea nitrogen levels compared to the control group. The HA group had a significantly higher 60-day postoperative survival rate compared to the control group. While the HA group experienced reduced in-hospital mortality and stroke incidence, only the reduction in stroke incidence showed a significant association with the intervention after adjusting for confounders.
CONCLUSION: The application of HA380 does not significantly reduce all postoperative inflammatory indicators in ATAAD surgery. The reduction in inflammatory response was also not obvious. However, it was associated with a significantly lower stroke incidence and improved 60-day survival, suggesting potential clinical benefits in specific outcomes. The specific mechanisms underlying the lower rates of stroke and mortality require further investigation.