Hemoperfusion integrated into the cardiopulmonary bypass circuit modifies perioperative inflammatory trajectories

BACKGROUND: Hemoperfusion has emerged as a potential extracorporeal blood purification strategy for attenuating inflammation during cardiopulmonary bypass (CPB), but perioperative biomarker trajectory data remain limited. This pilot comparative study evaluated whether integration of the HA380 cartridge into the CPB circuit was associated with altered postoperative inflammatory kinetics in adult cardiac surgery. METHODS: In this single-center, nonrandomized, biomarker-focused pilot study, 60 adult patients undergoing cardiac surgery with CPB were included, with 30 patients receiving HA380 hemoperfusion during CPB and 30 patients managed with conventional CPB alone. Serum levels of TNF-α, IL-1β, IL-6, IL-8, IL-10, and C-reactive protein (CRP) were measured at four standardized perioperative time points: T0 (preoperative baseline), T1 (end of surgery/ICU admission; 0 h), T2 (postoperative 24 h), and T3 (postoperative 48 h). Because treatment allocation was not randomized and baseline inflammatory imbalance was present, change-from-baseline and trajectory analyses were prioritized. RESULTS: The HA380 group entered surgery with a numerically higher baseline inflammatory burden. However, by postoperative 24 h and 48 h, most proinflammatory biomarkers in the HA380 group showed a downward trajectory or remained near baseline, whereas the control group demonstrated persistent postoperative elevation. This pattern was more clearly captured by change-from-baseline analyses than by crude postoperative absolute values alone. The composite inflammatory burden score decreased postoperatively in the HA380 group but increased progressively in the control group, supporting a global attenuation of inflammatory propagation rather than an isolated effect on a single cytokine. CONCLUSIONS: In this biomarker-focused pilot study, HA380 hemoperfusion integrated into the CPB circuit was associated with a more favorable postoperative inflammatory trajectory. These findings support the biologic plausibility of intraoperative hemoperfusion as an adjunct extracorporeal modulation strategy and justify further validation in larger studies.