Extracorporeal Cytokine Adsorption in Cardiac Surgery
Status:
Completed
Trial end date:
2018-06-01
Target enrollment:
Participant gender:
Summary
The modern era of cardiac surgery began in early 1950s with the introduction of
cardiopulmonary bypass (CPB). Although it has been clearly shown that CPB is almost
unavoidable for most open heart operations, an undesirable systemic inflammatory response
syndrome (SIRS) is associated with its use. This complex chain of events has strong
similarities with sepsis and may contribute to the development of postoperative complications
and multiple organ failure (MOF). It has been shown that an excessive compensatory
anti-inflammatory response (CARS) after SIRS can lead to immune paralysis and increased rate
of hospital acquired infection. The balance of pro-inflammatory and anti-inflammatory
mediators determines the inflammatory response and the clinical outcome. Accordingly, great
efforts have been focused on therapeutic interventions aimed at reducing the inflammatory
reactions during CPB, including pharmacologic strategies and modification of surgical
techniques or mechanical devices. Such therapies may provide improvements in patient outcome
after open heart operations. Among pharmacologic strategies is the prophylaxis with
corticosteroids, which have been used during open heart surgery for more than 30 years. Many
studies, both experimental and clinical, failed to produce evidence in favor of steroid
treatment. As far as medical devices are concerned, the use of extracorporeal cytokine filter
CytoSorb looks promising in cardiac surgery. It was recently approved by European Medicines
Agency as an active treatment to fight cytokine storm.
Serum paraoxonase 1 (PON1) is a lipo-lactonase, being associated with HDL that has an
anti-inflammatory role and protects against atherosclerosis. Low levels of PON1 are
associated with venous graft occlusion in patients with coronary artery bypass grafting. PON1
reduces monocyte chemotaxis and adhesion to endothelial cells, leading to inhibition of the
differentiation of monocytes into macrophages. The effects of cytokine adsorption therapy on
PON1 are unknown.
The aim of the study is to explore the effects of extracorporeal immunoadsorption during CPB
on pro-inflammatory and anti-inflammatory protective mediators and cellular immune status in
cardiac surgery.