A comprehensive analysis of intraoperative cytokine adsorption systems on early clinical outcomes after coronary artery bypass grafting

Background Cardiopulmonary bypass (CPB) induces a systemic inflammatory response mediated by cytokine release, which may contribute to postoperative cardiovascular and systemic organ dysfunction following coronary artery bypass grafting (CABG). Cytokine adsorption filters have been developed to attenuate this response; however, their clinical efficacy in CABG remains controversial and a matter of debate among physicians and healthcare systems. Methods This observational study compared early postoperative outcomes in 17 patients undergoing CABG with intraoperative cytokine adsorption using two different filter systems and 28 control patients undergoing CABG without cytokine filtration. Baseline demographic and operative characteristics were recorded. Clinical outcomes and inflammatory and biochemical markers, including C-reactive protein (CRP), procalcitonin, ferritin, interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α), were measured at predefined perioperative time points. Results Baseline characteristics were comparable between groups, and no significant differences were observed between the two filter systems. Exploratory subgroup analyses stratified by hypertension and diabetes mellitus did not demonstrate a differential effect of cytokine filtration on the assessed outcomes. Compared with the Control group, the Filter group demonstrated a significantly shorter duration of mechanical ventilation (median 4 vs. 13 hours; p = 0.041) and a substantially lower requirement for inotropic support (5.8% vs. 60.7%; p < 0.001). Intra-aortic balloon pump use and re-exploration rates were significantly lower in the Filter group. Lactate levels following CPB and during the early postoperative period were significantly lower in the Filter group. Among inflammatory markers, only IL-8 levels at 24 hours postoperatively were significantly reduced, while IL-6, IL-10, TNF-α, and CRP showed no significant intergroup differences. Conclusions Intraoperative cytokine adsorption during CABG was associated with improved early postoperative clinical outcomes despite limited effects on most circulating inflammatory markers. These findings are hypothesis-generating and warrant confirmation in adequately powered randomized controlled trials to inform clinicians’ decision-making regarding their use in patients.