Hemoadsorption contribution in neonatal cardiac surgery

Abstract

Background: Cardiopulmonary bypass (CPB) in paediatric open-heart surgery is challenging, especially in neonates and aortic arch surgery. It induces a systemic inflammatory response that can lead to significant postoperative complications, including multiorgan dysfunction, prolonged mechanical ventilation, and intensive care unit (ICU) stay. Blood purification with hemoadsorbers integrated into CPB has been proposed as a strategy to reduce these side effects. These devices adsorb cytokines from the bloodstream, trying to modulate their negative systemic effect.

Methods: This retrospective study evaluates 33 neonates who underwent complex cardiac surgeries between January 2022 and January 2025 at Regina Margherita Children's Hospital. 17 of them had been treated with Jafron HA60 hemoadsorber during CPB. Biomarkers of organ damage (creatinine, lipase, aspartate transaminase, and alanine transaminase), C-reactive protein, lactates, inotropic drugs doses and a wide range of pro- and anti-inflammatory cytokines were analysed during surgery and in the intensive care unit.

Results: The results showed a decrease in biomarkers of organ damage and inflammation, accompanied by a tendency toward reduction in the required dose of inotropes, ICU stays, days of mechanical ventilation, and duration of required open chest time in the treated group. A similar downward pattern was observed in cytokine levels.

Conclusions: Hemoadsorption may be associated with improved clinical parameters in neonates undergoing high-risk cardiac surgery. Further large-scale studies are needed to explore these observations.

Keywords: cardiopulmonary bypass; cytokine; hemoadsorption; inflammatory response; neonatal cardiac surgery; pediatric cardiac surgery.

Figure 1

Integration of the hemoadsorption device into the cardiopulmonary bypass (CPB) circuit. Oxygenated blood is taken from the oxygenator of the heart-lung machine and goes through the adsorber to the venous reservoir.

Figure 2

Laboratory results are shown in liner graphs. A) Creatinine; B) lipase; C) AST and D) ALT. All values were collected at admission to the ICU and at 6, 12, 36 and 60 h. For each value and statistical analysis, see Table 3.

Figure 3

Inflammation values and VIS values are shown in linear graphs. A) VIS levels on arrival at ICU, at 6, 12, 24,48 and 72 h; B) LAC levels after CPB disconnection, on arrival at ICU, at 6, 12, 24 h; C) C-reactive protein (CRP) levels on arrival at ICU, at 12, 36 and 60 h. For each value and statistical analysis, see Table 3.

Figure 4

Trends in inflammatory cytokine levels, showing median values for the HA60-treated (blue) and control (orange) groups. Timepoints are represented in Table 1.