Effects of Blood Hemoadsorption Therapy with HA-380 in Total Arch Replacement for Acute Type A Aortic Dissection: A Retrospective Observational Study

医学 肾脏替代疗法 围手术期 主动脉夹层 急性肾损伤 回顾性队列研究 外科 体外循环 胃肠病学 麻醉 内科学 主动脉
作者
Juxiang Wang,Bin Chen,Junhao Xie,Huilong Chen,Lihua Li,Weiqun Zhang,Lin Lü
出处
期刊:Blood Purification [S. Karger AG]
卷期号:53 (2): 138-150
标识
DOI:10.1159/000534852
摘要

<b><i>Introduction:</i></b> This study aimed to evaluate whether the addition of a hemoadsorption (HA) cartridge, HA-380, in the cardiopulmonary bypass (CPB) circuit in acute type A aortic dissection (ATAAD) surgery reduced inflammatory cytokine levels and decreased postoperative complications. <b><i>Methods:</i></b> A retrospective observational cohort study was conducted between March 1, 2021, and February 28, 2022. Patients with ATAAD undergoing emergent total arch replacement surgery were divided into the control (CON) and HA groups on the basis of the addition of the HA-380 cartridge in the CPB circuit. <b><i>Results:</i></b> Overall, 121 patients met the eligibility criteria; 2 patients in each group who died within the first postoperative week were excluded. Further, 57 and 60 patients in the CON and HA groups, respectively, were included in the pooled analysis. The major perioperative data, baseline values of interleukin-6 (IL-6) and C-reactive protein, and therapeutic interventions were similar in the two groups (all, <i>p &gt; 0.05</i>). The serum IL-6 levels increased more rapidly in the CON group than those in the HA group postoperatively (205.73 ± 174.72 vs. 146.13 ± 64.15 pg/mL, <i>p</i> = 0.020). The HA group had a lower incidence of postoperative acute kidney injury (AKI) and severe acute respiratory distress syndrome than the CON group (25.4 vs. 44.6%, <i>p</i> = 0.032 and 18.3 vs. 35.1%, <i>p</i> = 0.040, respectively). Logistic regression analyses showed that HA may be a protective factor against postoperative AKI. The incidence of bleeding, delirium, and stroke as well as the lengths of intensive care unit and hospital stay in both groups were similar (all, <i>p &gt;</i> 0.05). <b><i>Conclusions:</i></b> The use of HA-380 in the CPB circuit may attenuate inflammatory response and reduce major complications following ATAAD surgery. HA may be associated with lower rate of postoperative AKI.
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