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Minerva Anestesiologica 2020 Jul 08

DOI: 10.23736/S0375-9393.20.14525-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Haemoadsorption: effective in reducing circulating fragments of the endothelial glycocalyx during cardiopulmonary bypass in patients undergoing on-pump cardiac surgery?

Andreas HOHN 1, 2 , Andreas BAUMANN 3, Eva PIETROSCHINSKY 1, Jeremy FRANKLIN 4, Anja ILLERHAUS 5, Dirk BUCHWALD 6, Jochen HINKELBEIN 1, Peter K. ZAHN 3, Thorsten ANNECKE 1, 7

1 Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany; 2 Kliniken Maria Hilf, Department of Anaesthesiology and Intensive Care Medicine, Moenchengladbach, Germany; 3 Department of Anaesthesiology, Intensive Care, Palliative Care and Pain Medicine, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany; 4 Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany; 5 Department of Dermatology, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany; 6 Department of Cardiac and Thoracic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany; 7 Department of Anaesthesiology and Intensive Care Medicine, Kliniken der Stadt Köln gGmbH, University of Witten Herdecke, Cologne, Nordrhein-Westfalen, Germany


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BACKGROUND: The vascular endothelial glycocalyx is susceptible to ischaemia and hypoxia. Released soluble components of the endothelial glycocalyx (EG) have been identified as potential damage associated molecular patterns (DAMPs) able to enhance an ongoing inflammatory response. Shedding of the EG has been associated with released atrial-natriuretic peptide (ANP) during cardiac surgery procedures. A novel haemoadsorption technique (CytoSorb®) has been shown to effectively remove molecules up to 55 kDa unspecifically from circulation. It is not known whether ANP or glycocalyx components can be removed successfully by this technique.
METHODS: In 15 patients undergoing on-pump cardiac surgery, the haemoadsorption device was integrated in the cardiopulmonary bypass (CPB) circuit. Pre- and post-adsorber concentrations of ANP, heparan sulphate (HEP), syndecan-1 (SYN) and hyaluronan (HYA) were measured at 10 (T1), 30 (T2), and 60 (T3) minutes after aortic cross-clamping and complete CPB.
RESULTS: Haemoadsorption significantly reduced mean HEP concentrations (-157.5 [333.4] ng/ml; p<0.001) post adsorber. For ANP and SYN no statistically significant changes were detected whereas mean [SD] HYA concentrations even increased significantly (+21.6 [43.0] ng/ml; p < 0.001) post adsorber.
CONCLUSIONS: In this study representing a real-life scenario, we could demonstrate that the novel hemoadsorption device (CytoSorb®) was able to effectively adsorb HEP from the circulation if integrated in a CPB circuit. However, blood concentrations of HYA, SYN, and ANP could not be reduced during CPB in our investigation.


KEY WORDS: Glycocalyx; Cardiac surgery; Cardiopulmonary bypass

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