Hemadsorption in cardiac surgery: myth against reality

Cardiopulmonary bypass (CPB) surgery determines an unpredictable activation of a systemic inflammatory response induced by extrinsic and intrinsic factors.once activated by the extracorporeal circuit, this may lead to a dysregulation of inflammatory homeostasis, with increased levels of both pro-inflammatory — interleukin 1β (IL-1β) and tumor necrosis factor α (TNF-α) — and anti-inflammatory — IL-6, IL-8, IL-10 — plasma mediators. Both an excessive increase of pro-inflammatory plasma cytokines and an imbalance of pro- and anti-inflammatory mediators seem predictive for postoperative organ dysfunction and major complications, such as postoperative infection rates, mechanical ventilation need, prolonged postoperative course, thus for an unfavorable outcome. The elimination of both pro- and anti-inflammatory cytokine is supposed to reduce not only the inflammatory response but also the eventual immune imbalance; indeed, small molecules as cytokines may be eliminated by adsorption depending on their plasma concentration using the hemadsorption technique, with a possible improvement of cardiovascular function.