The effect of hemoadsorption to postoperative outcomes of patients with Stanford Type A Aortic Dissection

The effect of hemoadsorption to postoperative outcomes of patients with Stanford Type A Aortic Dissection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of hemoadsorption to postoperative outcomes of patients with Stanford Type A Aortic Dissection Bing Liu, Haiyuan Liu, Shuaipeng Zhang, Xue Wei, Shenglin Ge This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8353179/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 19 You are reading this latest preprint version Abstract Objective To investigate the effect of hemoadsorption on short-term outcomes of patients with Stanford Type A Aortic Dissection. Method The clinical data of 100 patients with TAAD from January 2021 to June 2023 were retrospectively analyzed. Patients were divided into HA group and CON group, depending on the usage of hemoadsorption during the cardiopulmonary bypass, with 50 patients in each group. The comparison between two groups including surgery-related indicators such as cardiopulmonary time, surgery time, clamping time, Deep Hypothermia Cardiac Arrest time, ultrafiltration volume, urine output as well as blood transfusion and clinical laboratory tests such as white cell count, aspartate aminotransferase, alanine transaminase, creatinine as well as blood urea nitrogen. All these tests were measured before surgery, at 24hrs and 48hrs after surgery. Results There was no significant difference for both baseline materials and surgery-related indicators between two groups (P>0.05). Compared with CON group, aspartate aminotransferase, alanine transaminase, creatinine and blood urea nitrogen in HA group improved, especially for alanine transaminase. Conclusion Hemoadsorption is valuable in improving and protecting liver and renal function within short-term period after TAAD surgery. Stanford Type A aortic dissection hemoadsorption cardiopulmonary bypass Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction As a kind of critical disease in cardiac vascular surgery, Stanford Type A Aortic Dissection (TAAD) is defined as a fatal injury of aortic wall caused by a series risk factors, mainly, such as hypertension and potentially, entire aortic structure including ascending aorta, arch, and descending aorta as well as branches may be involved [1]. Nowadays, surgical repair is the preferred option for TAAD treatment, however, it has been found that the postoperative outcome is not optimistic due to longer surgical procedure, trauma and various related complications. Especially, cardiopulmonary bypass (CPB) is associated with the activation of inflammatory factors leading to adverse events [2]. Recently, although more evidence-based studies are needed, hemoadsorption has been still gradually introduced into the treatment of patients undergoing cardiac surgery with the aim to purify blood, inhibit inflammation as well as improve postoperative outcome through removing toxic and inflammatory factors within circulation system [3]. Based on the current researches and literature, in our study, the hemoadsorption is connected into the circuit of CPB during TAAD surgical procedure to assess its effect to postoperative outcomes. 1. Clinical materials 1.1 Subjects A retrospective analysis was performed. A total of 100 patients with TAAD in the department of cardiovascular surgery, the First Affiliated Hospital of Anhui Medical University from Jan. 2021 to Jun. 2023 were enrolled. In accordance with the usage of hemoadsorption, all patients were divided into hemoadsorption group (HA, n = 50) and control group (CON, n = 50). In HA group, HA-380 (Jafron Biomedical, Guangdong, China) was connected to the circuit of CPB and used during entire CPB period, by contrast, in CON group, regular CPB was adopted. The inclusion criteria of patients were (1) Age ≥ 18 years; (2) A definitive diagnosis of TAAD by images; (3) Surgery completed. The exclusion criteria of patients were (1) Severe organ dysfunction before surgery; (2) Severe underlying disease such as malignant tumor before surgery; (3) Unstable circulation or signs of malperfusion including shock, disturbance of consciousness, abdominal pain/distension; (4) Repeated clamp and difficulty in CPB weaning during surgery as well as low cardiac output syndrome; (5) Delayed chest closure; (6) Unplanned discharge or death within short period after surgery; (7) ECMO support after surgery. This study was approved by the ethics committee of the First Affiliated Hospital of Anhui Medical University (No.PJ2024-01-50). All patients and their relatives have signed informed consent before treatment.Also, all methods in the current study were performed in accordance with the relevant guidelines and regulations. 1.2 CPB procedure The patients in two groups underwent combined intravenous-inhalation anesthesia and then median sternotomy. CPB was established via femoral + right axillary or innominate artery and vena cava route. During CPB, cardioplegia was performed after clamp of ascending aorta and deep hypothermia circulatory arrest (DHCA) combined with cerebral perfusion (5 ~ 8ml/kg.min) strategy was adopted at 25°C and hemoadsorption was stopped temporarily. After trunk implantation and artificial vascular anastomosis were completed, systematic perfusion was reactivated and temperature was also rewarmed evenly. The ascending aorta was declamped at 32°C. CPB was weaned at 36°C when both vital signs and gas analysis were stable. 1.3 Variables Both surgery-related indicators and clinical laboratory tests in two groups were compared. Surgery-related indicators included CPB time, surgery time, clamping time, DHCA time, ultrafilteration, urine output and blood transfusion volume.Clinical laboratory tests included white cell count (WBC), aspartate transamnase (AST), alanine transsaminase (ALT), creatinine (CRE), and blood urea nitrogen (BUN) and all these tests were measured before surgery,24hrs and 48hrs after surgery, respectively. 1.4 Statistical analysis SPSS 22.0 software was used for statistical analysis. The count data were expressed as percentages, and chi-square or Fisher's exact test was used for intra-group comparison. Normally distributed measurement data was expressed as ̅‾x ± s and ttest was used for intra-group comparison. While, non-normally distributed measurement data was expressed as M(P 25 , P 75 ) and Mann-Whitney U test was used for intra-group comparison. Generalized estimation equation (GEE) was used to analyze repeatedly measured clinical laboratory tests, WBC, AST, ALT, CRE and BUN. P < 0.05 was considered as significance. 2. Results 2.1 The comparison for characteristics of baseline materials in two groups The baseline materials of patients with TAAD before surgery in HA and CON groups were not significant (P > 0.05 , Table 1 ). Table 1 The baseline materials of patients with TAAD before surgery in HA and CON groups Groups n Age (yrs) Gender (%) Weight (kg) Hypertension (%) Diabetes Mellitus (%) left ventricular ejection fraction (%) Male Female HA 50 52.08 ± 10.62 35(70.0) 15(30.0) 73.96 ± 11.55 36(72.0) 3(6.0) 59.80 ± 3.77 CON 50 50.56 ± 11.95 35(70.0) 15(30.0) 72.96 ± 12.19 38(76.0) 2(4.0) 60.44 ± 2.96 t/x 2 -0.673 0.000 -0.673 0.208 0.211 0.944 P 0.503 1.000 0.675 0.648 0.646 0.348 2.2 The comparison for surgery-related indicators in two groups The surgery-related indicators in HA and CON groups were not significant (P > 0.05 , Table 2 ). Table 2 The surgery-related indicators in HA and CON groups Groups n CPB (min) Surgery (min) Clamping (min) DHCA (min) Ultrafilteration (ml) Urine (ml) Transfusion (U) HA 50 246.12 ± 41.69 484.60 ± 96.54 208.54 ± 39.76 27.32 ± 4.85 4250.00 ± 1206.15 801.00 ± 495.13 0.00(0.00,2.00) CON 50 250.88 ± 49.69 514.10 ± 79.77 203.24 ± 55.78 29.34 ± 9.97 3984.00 ± 1388.20 897.00 ± 649.21 0.00(0.00,1.63) t/Z 0.519 1666 -0.548 1.288 -1.023 0.831 -0.860 P 0.605 0.099 0.585 0.201 0.309 0.408 0.390 2.3. The comparison for clinical laboratory tests in two groups The GEE was used to analyze repeatedly measured tests before surgery, 24hrs and 48hrs after surgery, respectively. Based on the findings of GEE, it was demonstrated that hemoadsorption was effective in short-term function improvement of liver and renal after surgery ( Table 3 ). Table 3 The GEE analysis for repeatedly measured clinical laboratory tests in HA and CON groups Variables β Wald P 95%CI WBC CON Ref HA 0.510 0.739 0.390 1.665(0.521–5.320) Before surgery*CON Ref 24hrs after surgery*CON 1.193 5.307 0.021 3.298(1.195–9.104) 48hrs after surgery*CON 4.913 50.231 0.000 136.074(34.970-529.491) Before surgery*HA Ref 24hrs after surgery*HA 2.165 18.358 0.000 8.713(3.287–23.454) 48hrs after surgery*HA 6.424 122.749 0.000 616.341(197.828-1920.231) AST CON HA 15.880 0.089 0.766 7.89E + 6(3.365E-39-1.846E + 52) Before surgery*CON Ref 24hrs after surgery*CON 194.440 8.150 0.004 2.781E + 84(2.959E + 26-2.614E + 142) 48hrs after surgery*CON 157.920 6.284 0.012 3.835E + 68(9.122E + 14-1.613E + 122) Before surgery*HA 24hrs after surgery*HA 33.720 18.288 0.000 4.410E + 14(8.56E + 07-2.271E + 21) 48hrs after surgery*HA -22.640 0.405 0.525 1.471E-10(7.383E-41-2.930E + 20) ALT CON Ref HA -45.707 2.434 0.119 1.412E-20(1.630E-45-1.223E + 05) Before surgery*CON Ref 24hrs after surgery*CON 26.920 2.744 0.098 4.911E + 11(0.007-3.342E + 25) 48hrs after surgery*CON 42.010 4.498 0.034 1.757E + 18(24.183-1.276E + 35) Before surgery*HA Ref 24hrs after surgery*HA -0.006 0.000 0.998 0.994(0.013–75.052) 48hrs after surgery*HA 12.200 1.122 0.289 1.177E + 53(7.556E-46-1.833E + 151 BUN CON HA -0.138 0.081 0.776 0.871(0.336–2.260) Before surgery*CON Ref 24hrs after surgery*CON 3.723 82.205 0.000 41.380(18.505–92.533) 48hrs after surgery*CON 8.293 181.577 0.000 3995.005(1195.837-13346.355) Before surgery*HA Ref 24hrs after surgery*HA 2.937 43.354 0.000 18.859(7.868–45.207) 48hrs after surgery*HA 6.733 72.608 0.000 839.998(178.505-3952.817) CRE CON Ref HA 16.864 2.863 0.091 2.108E-07(0.069-6.419E + 15) Before surgery*CON Ref 24hrs after surgery*CON 6.036 1.012 0.314 418.217(0.003-5.35E + 07) 48hrs after surgery*CON 25.942 13.975 0.000 1.847E + 11(2.289E + 05-1.490E + 17) Before surgery*HA Ref 24hrs after surgery*HA 16.700 13.656 0.000 1.789E + 07(2546.991-1.257E + 11) 48hrs after surgery*HA 17.604 5.187 0.023 4.419E + 07(11.647-1.677E + 14) 2.3.1 The tests of WBC in two groups In HA group, compared that before surgery, the levels of WBC at 24hrs and 48hrs after surgery increased by 2.615 (P < 0.001) and 6.424 (P < 0.001), respectively. In CON group, compared that before surgery, the levels of WBC at 24hrs and 48hrs after surgery increased by 1.193 (P = 0.021) and 4.913 (P < 0.001), respectively ( Fig. 1 ). 2.3.2 The tests of AST in two groups In HA group, compared that before surgery, the levels of AST at 24hrs and 48hrs after surgery increased by 33.720 (P < 0.001) and decreased by 22.640 (P = 0.525), respectively. In CON group, compared that before surgery, the levels of AST at 24hrs and 48hrs after surgery increased by 194.442 (P = 0.004) and 157.923 (P = 0.012), respectively ( Fig. 2 ). 2.3.3 The tests of ALT in two groups In HA group, compared that before surgery, the levels of ALT at 24hrs and 48hrs after surgery were not significant (P > 0.05). In CON group, compared that before surgery, the levels of ALT at 24hrs and 48hrs after surgery increased by 53.940 (P = 0.024) and 83.461 (P = 0.026), respectively ( Fig. 3 ). 2.3.4 The tests of BUN in two groups In HA group, compared that before surgery, the levels of BUN at 24hrs and 48hrs after surgery increased by 2.937 (P < 0.001) and 6.733 (P < 0.001), respectively. In CON group, compared that before surgery, the levels of BUN at 24hrs and 48hrs after surgery increased by 3.723 (P < 0.001) and 8.293 (P < 0.001), respectively ( Fig. 4 ). 2.3.5 The tests of CRE in two groups In HA group, compared that before surgery, the levels of CRE at 24hrs and 48hrs after surgery increased by 16.700 (P < 0.001) and 17.604 (P = 0.023), respectively. In CON group, compared that before surgery, the levels of CRE at 24hrs and 48hrs after surgery increased by 6.036 (P = 0.314) and 25.942 (P < 0.001), respectively ( Fig. 5 ). 3. Discussion Following the development of medical device and updating of clinical thoughts, typically, hemoadsorption has been used in the treatment of septic shock and acute respiratory distress syndrome (ARDS) to improve hyperinflammation status and immune dysfunction [4] . In a Meta analysis conducted by Szigetváry et al. [5] , it was found that, among patients with ARDS, the hemoadsorption was valuable in improving oxygenation and reducing concentration of various inflammatory factors and, meanwhile, without any severe device-related complications. Moreover, for the patients with secondary respiratory failure due to COVID-19 undergoing VV-ECMO, Geraci et al. [6] have demonstrated that both inflammatory markers and lactate decreased significantly and the administration of vasopressor agents also reduced under the intervention of hemoadsorption although is associated with thrombocytopenia and filtration of some special medications such as sedatives and neuromuscular blockade agents. Undoubtedly, CPB plays an important role in the surgical treatment of TAAD, by which, both replacement of involved aorta and reconstruction of implantable grafts can be completed smoothly and successfully. Whereas, it has been indicated that, during CPB, imbalance and hyperactivation of endogenous immune system caused by multiple mechanisms including traumatic stress, exposed artificial circuit positively mediate overloaded secretion and releasing of enormous inflammatory factors including interleukin-6 (IL-6), IL-8 and tumor necrosis factor α (TNF-α) and lead to final systemic inflammatory response syndrome (SIRS) [7] . In the latest decades, hemoadsorption has been applied in the field of cardiac surgery and a combination of hemoadsorption and CPB is widely acknowledged and confirmed as an outstanding strategy to inhibit inflammatory response during on-pump cardiac surgeries, however, the results from several literature still remain controversial. In the REMOVE study focusing on the assessment of hemoadsorption among patients with infective endocarditis (IE), the conclusion was not satisfactory, even though decreased inflammatory factors at the end of CPB, nevertheless, there were no significance in postoperative organic protection, 30-day mortality and ICU stay [8] . Interestingly, opposed opinion was obtained from another clinical study conducted by Haidari et al. [9] , it was indicated that intraoperative hemoadsorption is a protective factor of patients with IE to reduce sepsis-related mortality and alleviate severity of sepsis. Furthermore, Manohar et al. [10] have shown a promised conclusion in a real-world study that among special patients with complex heart diseases undergoing combined cardiac surgical procedures, hemoadsorption is more reliable to maintain the hemodynamic stability and decrease mortality. Additionally, in valve surgical procedures, patients who underwent hemoadsorption showed significantly reduced lactate, platelet count, and improved AST after surgery, also, the shorter mechanical ventilation [11] . In this study, domestic HA-380 belongs to resin-based series of hemoadsorption with predominated adsorption effect and biocompatibility on both inflammatory factors and oxidative metabolites with a range of 10 ~ 60kDa [12] . Currently, HA-series resin hemoadsorption has been used increasingly on organic protection for patients with critical ill and among which, both HA-330 and HA-380 are indicative reasonably to the treatment of severe inflammatory response including sepsis, trauma, burns, pancreatitis, COVID-19, and hypercytokinemia with the aim to effectively reduce mortality and organic failure [13–15] . In a comparison study, it has been found that compared with CytoSorb® 300, HA-380 is comparable in cytokines absorption although less effective within the first 2hrs [16] . In a clinical study concentrating on the patients with septic shock, HA-380, as a supporting role, was run for 4 ~ 6hrs once, subsequently, after hemoadsorption, hemodynamic was stable accompanied with reduced lactic acid and elevated oxygenation [17] . Based on the findings of our study, it was concluded that HA-380 was significant for short-term preliminary organic improvement, especially for liver function protection, which was similar with that from another observational study emphasizing the protective effect of HA-380 on renal function [18] . In accordance with GEE analysis, the ALT in HA group was relative stable at 3 three measurements, before surgery, 24hrs and 48hrs after surergy, while the other 3 tests in HA group, compared with CON group, increased slowly and were lower at the same point, which suggested that, to some extent, HA-380 mitigated organic damage after TAAD surgery. Of note, there are also some limitations in this study. Firstly, this is a retrospective analysis from a single center, therefore, the sample size is relatively small and the bias may be not avoidable. Secondly, the number of observational variables is not comprehensive, especially, the assays for inflammatory factors are not determined. Thirdly, as a initial introduced device, besides connection with circuit of CPB, more time should be needed to explore the optimal usage of hemoadsorption. 4. Conclusion In conclusion, HA380 hemoadsorptionis effective in improving short-term outcomes and protecting postoperative organic function after TAAD surgeries. In future, large multicenter studies are necessary to assess clinical significance of hemoadsorption and obtain more clear details about its usage in the field of cardiovascular surgery. Declarations Funding The authors declare that no funds, grants, or other support were received. Author Contribution Bing Liu is responsible for manuscript writing and study designing; Haiyuan Liu, Shuaipeng Zhang and Xue Wei are responsible for data collection; Shenglin Ge is responsible for manuscript reviewing. Data Availability The datasets used and analysed during this study are available from the corresponding author on reasonable request. References 1. Chukwu M, Ehsan P, Aburumman RN, et al. Acute Stanford Type A Aortic Dissection: A Review of Risk Factors and Outcomes. Cureus, 2023, 15(3):e36301. 2. Hinoue T, Yatabe T, Nishida O. Prediction of postoperative atrial fibrillation with the systemic immune-inflammation index in patients undergoing cardiac surgery using cardiopulmonary bypass: a retrospective, single-center study. J Artif Organs, 2023, 26(2):112–118. 3. Matejic-Spasic M, Lindstedt S, Lebreton G, et al. The role of hemoadsorption in cardiac surgery - a systematic review. BMC Cardiovasc Disord, 2024, 24(1):258. 4. Hawchar F, Tomescu D, Träger K, et al. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry. PLoS One, 2022,17(10):e0274315. 5. Szigetváry CE, Turan C, Kovács EH, et al. Hemoadsorption as Adjuvant Therapy in Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis. Biomedicines, 2023, 11(11):3068. 6. Geraci TC, Kon ZN, Moazami N, et al. Hemoadsorption for management of patients on veno-venous ECMO support for severe COVID-19 acute respiratory distress syndrome. J Card Surg, 2021, 36(11):4256–4264. 7. Yang Y, Yang X, Yang J. Cholinesterase level is a predictor of systemic inflammatory response syndrome and complications after cardiopulmonary bypass. Ann Palliat Med, 2021, 10(11):11714–11720. 8. Diab M, Lehmann T, Bothe W, et al. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation, 2022, 145(13):959–968. 9. Haidari Z, Demircioglu E, Boss K, et al. Intraoperative hemoadsorption in high-risk patients with infective endocarditis. PLoS One, 2022, 17(7):e0266820. 10. Manohar M, Jawali V, Neginahal S, et al. Hemoadsorption in Complex Cardiac Surgery-A Single Center Experience. J Clin Med, 2022, 11(23):7005. 11. Yang K, Huang H, Dai R, et al. Efficacy of Hemoperfusion Cartridge Procedure on Patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass. Heart Surg Forum, 2023, 26(1):E020-E026. 12. Pomarè Montin D, Ankawi G, Lorenzin A, et al. Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion. Blood Purif, 2018, 46(3):187–195. 13. Ricci Z, Romagnoli S, Reis T, et al. Hemoperfusion in the intensive care unit. Intensive Care Med, 2022, 48(10):1397–1408. 14. Borazjani R, Mahmudi-Azer S, Taghrir MH, et al. Adjunctive hemoperfusion with Resin Hemoadsorption (HA) 330 cartridges improves outcomes in patients sustaining multiple Blunt Trauma: a prospective, quasi-experimental study. BMC Surg, 2023, 23(1):148. 15. Surasit K, Srisawat N. The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study. Blood Purif, 2022, 51(11):879–888. 16. Nierhaus A, Morales J, Wendt D, et al. Comparison of the CytoSorb® 300 mL and Jafron HA380 hemoadsorption devices: an in vitro study. Minim Invasive Ther Allied Technol, 2022, 31(7):1058–1065. 17. Chen L, Zhou SL, Wang C, et al. Efficacy of HA380 hemoperfusion in the treatment of septic shock. J Transl Crit Care Med, 2024, 6:e24-00008. 18. Wang J, Chen B, Xie J, et al. Effects of Blood Hemoadsorption Therapy with HA-380 in Total Arch Replacement for Acute Type A Aortic Dissection: A Retrospective Observational Study. Blood Purif, 2024,53(2):138–150. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8353179","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585357664,"identity":"f61cc67f-c388-4e45-ad2f-11f7b92e8ba2","order_by":0,"name":"Bing Liu","email":"","orcid":"","institution":"The first affiliated hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Liu","suffix":""},{"id":585357665,"identity":"eddcd778-1254-45b2-969a-0ef7eb652b9e","order_by":1,"name":"Haiyuan Liu","email":"","orcid":"","institution":"The first affiliated hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haiyuan","middleName":"","lastName":"Liu","suffix":""},{"id":585357666,"identity":"eb72ed5d-07b2-48d0-a2e5-9ae24d8a44f1","order_by":2,"name":"Shuaipeng Zhang","email":"","orcid":"","institution":"The first affiliated hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shuaipeng","middleName":"","lastName":"Zhang","suffix":""},{"id":585357667,"identity":"5f67b73a-640c-4883-9ded-23f2cbb1f9cf","order_by":3,"name":"Xue Wei","email":"","orcid":"","institution":"The first affiliated hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Wei","suffix":""},{"id":585357668,"identity":"fd780d95-eca2-4871-8273-3a1c4065de32","order_by":4,"name":"Shenglin Ge","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYLCCBAYGOcb2xsYHH0jRYszcc7jZcAYpFiW2z0hvk+YgRqnB8d5jEg9q7hjzznzYIM3AYCen20BIy5lzyQYJx57JSc5ObDAuYEg2NjtAQIvZjRzDBwlsh40NgVqSZzAcSNxGUMv9NwYHEv4dTtx/82DDYR6itNzgMXyQ2HY4sXEGY2MzUVrsz+QYGyT2HTZm7ElsZpxhQIRfJNvPmEn++HYYGJXHn//4UGEnR1ALGjAgTfkoGAWjYBSMAhwAAEQiSdOXAlUqAAAAAElFTkSuQmCC","orcid":"","institution":"The first affiliated hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Shenglin","middleName":"","lastName":"Ge","suffix":""}],"badges":[],"createdAt":"2025-12-13 13:53:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8353179/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8353179/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101852247,"identity":"55171b2c-86f1-4d6a-8704-848847bcca97","added_by":"auto","created_at":"2026-02-04 10:11:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19158,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe levels of WBC before surgery, 24hrs and 48hrs after surgery in HA and CON groups\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRed line: HA group; Blue line: CON group; 1=Before surgery; 2=24hrs after surgery; 3=48hrs after surgery\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/0a653f6bf879253db4656422.png"},{"id":101882055,"identity":"ee7f53cf-2134-4129-8b45-49ea7f9f3bf4","added_by":"auto","created_at":"2026-02-04 15:20:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":18334,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe levels of AST before surgery, 24hrs and 48hrs after surgery in HA and CON groups\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRed line: HA group; Blue line: CON group; 1=Before surgery; 2=24hrs after surgery; 3=48hrs\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/cbcddfdf5f1ea758fbcff84c.png"},{"id":101852227,"identity":"7a19f156-a318-41f6-9c90-4dae19bb446e","added_by":"auto","created_at":"2026-02-04 10:11:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16412,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe levels of ALT before surgery, 24hrs and 48hrs after surgery in HA and CON groups\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRed line: HA group; Blue line: CON group; 1=Before surgery; 2=24hrs after surgery; 3=48hrs after surgery\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/21040868147d1ea6e01342bd.png"},{"id":101852244,"identity":"3c5a0417-6d78-4371-8984-3d5a9753b1ac","added_by":"auto","created_at":"2026-02-04 10:11:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":19376,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe levels of BUN before surgery, 24hrs and 48hrs after surgery in HA and CON groups\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRed line: HA group; Blue line: CON group; 1=Before surgery; 2=24hrs after surgery; 3=48hrs after surgery\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/2444219e863510f710ef3e1c.png"},{"id":101852249,"identity":"4e8a9c24-36ab-41b9-892f-2813e27e1ba6","added_by":"auto","created_at":"2026-02-04 10:11:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":16944,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe levels of CRE before surgery, 24hrs and 48hrs after surgery in HA and CON groups\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eRed line: HA group; Blue line: CON group; 1=Before surgery; 2=24hrs after surgery; 3=48hrs after surgery\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/84f27ea13b265beac9f0c93e.png"},{"id":101883664,"identity":"100a380e-a8de-44de-be99-e30e3c48cdaf","added_by":"auto","created_at":"2026-02-04 15:29:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1300723,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8353179/v1/c4c7d471-6ace-4738-aeb6-8304b7d7fcc8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of hemoadsorption to postoperative outcomes of patients with Stanford Type A Aortic Dissection","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eAs a kind of critical disease in cardiac vascular surgery, Stanford Type A Aortic Dissection (TAAD) is defined as a fatal injury of aortic wall caused by a series risk factors, mainly, such as hypertension and potentially, entire aortic structure including ascending aorta, arch, and descending aorta as well as branches may be involved [1]. Nowadays, surgical repair is the preferred option for TAAD treatment, however, it has been found that the postoperative outcome is not optimistic due to longer surgical procedure, trauma and various related complications. Especially, cardiopulmonary bypass (CPB) is associated with the activation of inflammatory factors leading to adverse events [2]. Recently, although more evidence-based studies are needed, hemoadsorption has been still gradually introduced into the treatment of patients undergoing cardiac surgery with the aim to purify blood, inhibit inflammation as well as improve postoperative outcome through removing toxic and inflammatory factors within circulation system [3]. Based on the current researches and literature, in our study, the hemoadsorption is connected into the circuit of CPB during TAAD surgical procedure to assess its effect to postoperative outcomes.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"1. Clinical materials","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Subjects\u003c/h2\u003e \u003cp\u003e\u003cem\u003eA retrospective analysis was performed. A total of 100 patients with TAAD in the department of cardiovascular surgery, the First Affiliated Hospital of Anhui Medical University from Jan. 2021 to Jun. 2023 were enrolled. In accordance with the usage of hemoadsorption, all patients were divided into hemoadsorption group (HA, n\u0026thinsp;=\u0026thinsp;50) and control group (CON, n\u0026thinsp;=\u0026thinsp;50). In HA group, HA-380 (Jafron Biomedical, Guangdong, China) was connected to the circuit of CPB and used during entire CPB period, by contrast, in CON group, regular CPB was adopted. The inclusion criteria of patients were (1) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (2) A definitive diagnosis of TAAD by images; (3) Surgery completed. The exclusion criteria of patients were (1) Severe organ dysfunction before surgery; (2) Severe underlying disease such as malignant tumor before surgery; (3) Unstable circulation or signs of malperfusion including shock, disturbance of consciousness, abdominal pain/distension; (4) Repeated clamp and difficulty in CPB weaning during surgery as well as low cardiac output syndrome; (5) Delayed chest closure; (6) Unplanned discharge or death within short period after surgery; (7) ECMO support after surgery. This study was approved by the ethics committee of the First Affiliated Hospital of Anhui Medical University (No.PJ2024-01-50). All patients and their relatives have signed informed consent before treatment.Also, all methods in the current study were performed in accordance with the relevant guidelines and regulations.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 CPB procedure\u003c/h2\u003e \u003cp\u003e \u003cem\u003eThe patients in two groups underwent combined intravenous-inhalation anesthesia and then median sternotomy. CPB was established via femoral\u0026thinsp;+\u0026thinsp;right axillary or innominate artery and vena cava route. During CPB, cardioplegia was performed after clamp of ascending aorta and deep hypothermia circulatory arrest (DHCA) combined with cerebral perfusion (5\u0026thinsp;~\u0026thinsp;8ml/kg.min) strategy was adopted at 25\u0026deg;C and hemoadsorption was stopped temporarily. After trunk implantation and artificial vascular anastomosis were completed, systematic perfusion was reactivated and temperature was also rewarmed evenly. The ascending aorta was declamped at 32\u0026deg;C. CPB was weaned at 36\u0026deg;C when both vital signs and gas analysis were stable.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Variables\u003c/h2\u003e \u003cp\u003e \u003cem\u003eBoth surgery-related indicators and clinical laboratory tests in two groups were compared. Surgery-related indicators included CPB time, surgery time, clamping time, DHCA time, ultrafilteration, urine output and blood transfusion volume.Clinical laboratory tests included white cell count (WBC), aspartate transamnase (AST), alanine transsaminase (ALT), creatinine (CRE), and blood urea nitrogen (BUN) and all these tests were measured before surgery,24hrs and 48hrs after surgery, respectively.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Statistical analysis\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSPSS 22.0 software was used for statistical analysis. The count data were expressed as percentages, and chi-square or Fisher's exact test was used for intra-group comparison. Normally distributed measurement data was expressed as ̅\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s and ttest was used for intra-group comparison. While, non-normally distributed measurement data was expressed as M(P\u003c/em\u003e \u003csub\u003e \u003cem\u003e25\u003c/em\u003e \u003c/sub\u003e, \u003cem\u003eP\u003c/em\u003e\u003csub\u003e\u003cem\u003e75\u003c/em\u003e\u003c/sub\u003e\u003cem\u003e) and Mann-Whitney U test was used for intra-group comparison. Generalized estimation equation (GEE) was used to analyze repeatedly measured clinical laboratory tests, WBC, AST, ALT, CRE and BUN. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significance.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 The comparison for characteristics of baseline materials in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eThe baseline materials of patients with TAAD before surgery in HA and CON groups were not significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe baseline materials of patients with TAAD before surgery in HA and CON groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGroups\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAge (yrs)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGender (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eWeight (kg)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHypertension (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eDiabetes Mellitus (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eleft ventricular ejection fraction (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e52.08\u0026thinsp;\u0026plusmn;\u0026thinsp;10.62\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e35(70.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e15(30.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e73.96\u0026thinsp;\u0026plusmn;\u0026thinsp;11.55\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e36(72.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3(6.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e59.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50.56\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e35(70.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e15(30.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e72.96\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38(76.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2(4.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/x\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.673\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.673\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.208\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.211\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.944\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.503\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.675\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.648\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.646\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.348\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 The comparison for surgery-related indicators in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eThe surgery-related indicators in HA and CON groups were not significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/em\u003e, Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe surgery-related indicators in HA and CON groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGroups\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCPB (min)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSurgery (min)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eClamping (min)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eDHCA (min)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eUltrafilteration (ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eUrine\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eTransfusion (U)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e246.12\u0026thinsp;\u0026plusmn;\u0026thinsp;41.69\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e484.60\u0026thinsp;\u0026plusmn;\u0026thinsp;96.54\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e208.54\u0026thinsp;\u0026plusmn;\u0026thinsp;39.76\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e27.32\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4250.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1206.15\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e801.00\u0026thinsp;\u0026plusmn;\u0026thinsp;495.13\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.00(0.00,2.00)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e250.88\u0026thinsp;\u0026plusmn;\u0026thinsp;49.69\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e514.10\u0026thinsp;\u0026plusmn;\u0026thinsp;79.77\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e203.24\u0026thinsp;\u0026plusmn;\u0026thinsp;55.78\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e29.34\u0026thinsp;\u0026plusmn;\u0026thinsp;9.97\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3984.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1388.20\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e897.00\u0026thinsp;\u0026plusmn;\u0026thinsp;649.21\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.00(0.00,1.63)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003et/Z\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.519\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1666\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.548\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.288\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-1.023\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.831\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.860\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.605\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.099\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.585\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.201\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.309\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.408\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.390\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"Section2\"\u003e\u003cstrong\u003e2.3. The comparison for clinical laboratory tests in two groups\u003c/strong\u003e\u003cbr\u003e\n \u003cp\u003e\u003cem\u003eThe GEE was used to analyze repeatedly measured tests before surgery, 24hrs and 48hrs after surgery, respectively. Based on the findings of GEE, it was demonstrated that hemoadsorption was effective in short-term function improvement of liver and renal after surgery (\u003c/em\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe GEE analysis for repeatedly measured clinical laboratory tests in HA and CON groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eWald\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eWBC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.510\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.739\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.390\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.665(0.521\u0026ndash;5.320)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.193\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.307\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.021\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.298(1.195\u0026ndash;9.104)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.913\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e50.231\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e136.074(34.970-529.491)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.165\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e18.358\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8.713(3.287\u0026ndash;23.454)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.424\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e122.749\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e616.341(197.828-1920.231)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e15.880\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.089\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.766\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e7.89E\u0026thinsp;+\u0026thinsp;6(3.365E-39-1.846E\u0026thinsp;+\u0026thinsp;52)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e194.440\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8.150\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.781E\u0026thinsp;+\u0026thinsp;84(2.959E\u0026thinsp;+\u0026thinsp;26-2.614E\u0026thinsp;+\u0026thinsp;142)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e157.920\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.284\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.012\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.835E\u0026thinsp;+\u0026thinsp;68(9.122E\u0026thinsp;+\u0026thinsp;14-1.613E\u0026thinsp;+\u0026thinsp;122)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e33.720\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e18.288\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.410E\u0026thinsp;+\u0026thinsp;14(8.56E\u0026thinsp;+\u0026thinsp;07-2.271E\u0026thinsp;+\u0026thinsp;21)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-22.640\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.405\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.525\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.471E-10(7.383E-41-2.930E\u0026thinsp;+\u0026thinsp;20)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-45.707\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.434\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.119\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.412E-20(1.630E-45-1.223E\u0026thinsp;+\u0026thinsp;05)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e26.920\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.744\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.098\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.911E\u0026thinsp;+\u0026thinsp;11(0.007-3.342E\u0026thinsp;+\u0026thinsp;25)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e42.010\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.498\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.034\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.757E\u0026thinsp;+\u0026thinsp;18(24.183-1.276E\u0026thinsp;+\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.006\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.998\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.994(0.013\u0026ndash;75.052)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12.200\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.122\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.289\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.177E\u0026thinsp;+\u0026thinsp;53(7.556E-46-1.833E\u0026thinsp;+\u0026thinsp;151\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-0.138\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.081\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.776\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.871(0.336\u0026ndash;2.260)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.723\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e82.205\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e41.380(18.505\u0026ndash;92.533)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8.293\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e181.577\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3995.005(1195.837-13346.355)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.937\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e43.354\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e18.859(7.868\u0026ndash;45.207)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.733\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e72.608\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e839.998(178.505-3952.817)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eHA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e16.864\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.863\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.091\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.108E-07(0.069-6.419E\u0026thinsp;+\u0026thinsp;15)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.036\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.012\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.314\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e418.217(0.003-5.35E\u0026thinsp;+\u0026thinsp;07)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*CON\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e25.942\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e13.975\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.847E\u0026thinsp;+\u0026thinsp;11(2.289E\u0026thinsp;+\u0026thinsp;05-1.490E\u0026thinsp;+\u0026thinsp;17)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBefore surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eRef\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e24hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e16.700\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e13.656\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.789E\u0026thinsp;+\u0026thinsp;07(2546.991-1.257E\u0026thinsp;+\u0026thinsp;11)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48hrs after surgery*HA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e17.604\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.187\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.023\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.419E\u0026thinsp;+\u0026thinsp;07(11.647-1.677E\u0026thinsp;+\u0026thinsp;14)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.1 The tests of WBC in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eIn HA group, compared that before surgery, the levels of WBC at 24hrs and 48hrs after surgery increased by 2.615 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 6.424 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively. In CON group, compared that before surgery, the levels of WBC at 24hrs and 48hrs after surgery increased by 1.193 (P\u0026thinsp;=\u0026thinsp;0.021) and 4.913 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively (\u003c/em\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.2 The tests of AST in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eIn HA group, compared that before surgery, the levels of AST at 24hrs and 48hrs after surgery increased by 33.720 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and decreased by 22.640 (P\u0026thinsp;=\u0026thinsp;0.525), respectively. In CON group, compared that before surgery, the levels of AST at 24hrs and 48hrs after surgery increased by 194.442 (P\u0026thinsp;=\u0026thinsp;0.004) and 157.923 (P\u0026thinsp;=\u0026thinsp;0.012), respectively (\u003c/em\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.3 The tests of ALT in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eIn HA group, compared that before surgery, the levels of ALT at 24hrs and 48hrs after surgery were not significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In CON group, compared that before surgery, the levels of ALT at 24hrs and 48hrs after surgery increased by 53.940 (P\u0026thinsp;=\u0026thinsp;0.024) and 83.461 (P\u0026thinsp;=\u0026thinsp;0.026), respectively (\u003c/em\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.4 The tests of BUN in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eIn HA group, compared that before surgery, the levels of BUN at 24hrs and 48hrs after surgery increased by 2.937 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 6.733 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively. In CON group, compared that before surgery, the levels of BUN at 24hrs and 48hrs after surgery increased by 3.723 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 8.293 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively (\u003c/em\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003e2.3.5 The tests of CRE in two groups\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eIn HA group, compared that before surgery, the levels of CRE at 24hrs and 48hrs after surgery increased by 16.700 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and 17.604 (P\u0026thinsp;=\u0026thinsp;0.023), respectively. In CON group, compared that before surgery, the levels of CRE at 24hrs and 48hrs after surgery increased by 6.036 (P\u0026thinsp;=\u0026thinsp;0.314) and 25.942 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), respectively (\u003c/em\u003eFig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003e \u003cem\u003eFollowing the development of medical device and updating of clinical thoughts, typically, hemoadsorption has been used in the treatment of septic shock and acute respiratory distress syndrome (ARDS) to improve hyperinflammation status and immune dysfunction\u003c/em\u003e \u003csup\u003e\u003cem\u003e[4]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eIn a Meta analysis conducted by Szigetv\u0026aacute;ry et al.\u003c/em\u003e \u003csup\u003e\u003cem\u003e[5]\u003c/em\u003e\u003c/sup\u003e, \u003cem\u003eit was found that, among patients with ARDS, the hemoadsorption was valuable in improving oxygenation and reducing concentration of various inflammatory factors and, meanwhile, without any severe device-related complications. Moreover, for the patients with secondary respiratory failure due to COVID-19 undergoing VV-ECMO, Geraci et al.\u003c/em\u003e \u003csup\u003e\u003cem\u003e[6]\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ehave demonstrated that both inflammatory markers and lactate decreased significantly and the administration of vasopressor agents also reduced under the intervention of hemoadsorption although is associated with thrombocytopenia and filtration of some special medications such as sedatives and neuromuscular blockade agents.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eUndoubtedly, CPB plays an important role in the surgical treatment of TAAD, by which, both replacement of involved aorta and reconstruction of implantable grafts can be completed smoothly and successfully. Whereas, it has been indicated that, during CPB, imbalance and hyperactivation of endogenous immune system caused by multiple mechanisms including traumatic stress, exposed artificial circuit positively mediate overloaded secretion and releasing of enormous inflammatory factors including interleukin-6 (IL-6), IL-8 and tumor necrosis factor α (TNF-α) and lead to final systemic inflammatory response syndrome (SIRS)\u003c/em\u003e \u003csup\u003e\u003cem\u003e[7]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eIn the latest decades, hemoadsorption has been applied in the field of cardiac surgery and a combination of hemoadsorption and CPB is widely acknowledged and confirmed as an outstanding strategy to inhibit inflammatory response during on-pump cardiac surgeries, however, the results from several literature still remain controversial. In the REMOVE study focusing on the assessment of hemoadsorption among patients with infective endocarditis (IE), the conclusion was not satisfactory, even though decreased inflammatory factors at the end of CPB, nevertheless, there were no significance in postoperative organic protection, 30-day mortality and ICU stay\u003c/em\u003e \u003csup\u003e\u003cem\u003e[8]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eInterestingly, opposed opinion was obtained from another clinical study conducted by Haidari et al.\u003c/em\u003e \u003csup\u003e\u003cem\u003e[9]\u003c/em\u003e\u003c/sup\u003e, \u003cem\u003eit was indicated that intraoperative hemoadsorption is a protective factor of patients with IE to reduce sepsis-related mortality and alleviate severity of sepsis. Furthermore, Manohar et al.\u003c/em\u003e \u003csup\u003e\u003cem\u003e[10]\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ehave shown a promised conclusion in a real-world study that among special patients with complex heart diseases undergoing combined cardiac surgical procedures, hemoadsorption is more reliable to maintain the hemodynamic stability and decrease mortality. Additionally, in valve surgical procedures, patients who underwent hemoadsorption showed significantly reduced lactate, platelet count, and improved AST after surgery, also, the shorter mechanical ventilation\u003c/em\u003e \u003csup\u003e\u003cem\u003e[11]\u003c/em\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn this study, domestic HA-380 belongs to resin-based series of hemoadsorption with predominated adsorption effect and biocompatibility on both inflammatory factors and oxidative metabolites with a range of 10\u0026thinsp;~\u0026thinsp;60kDa\u003c/em\u003e \u003csup\u003e\u003cem\u003e[12]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eCurrently, HA-series resin hemoadsorption has been used increasingly on organic protection for patients with critical ill and among which, both HA-330 and HA-380 are indicative reasonably to the treatment of severe inflammatory response including sepsis, trauma, burns, pancreatitis, COVID-19, and hypercytokinemia with the aim to effectively reduce mortality and organic failure\u003c/em\u003e \u003csup\u003e\u003cem\u003e[13\u0026ndash;15]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eIn a comparison study, it has been found that compared with CytoSorb\u0026reg; 300, HA-380 is comparable in cytokines absorption although less effective within the first 2hrs\u003c/em\u003e \u003csup\u003e\u003cem\u003e[16]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eIn a clinical study concentrating on the patients with septic shock, HA-380, as a supporting role, was run for 4\u0026thinsp;~\u0026thinsp;6hrs once, subsequently, after hemoadsorption, hemodynamic was stable accompanied with reduced lactic acid and elevated oxygenation\u003c/em\u003e \u003csup\u003e\u003cem\u003e[17]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eBased on the findings of our study, it was concluded that HA-380 was significant for short-term preliminary organic improvement, especially for liver function protection, which was similar with that from another observational study emphasizing the protective effect of HA-380 on renal function\u003c/em\u003e \u003csup\u003e\u003cem\u003e[18]\u003c/em\u003e\u003c/sup\u003e. \u003cem\u003eIn accordance with GEE analysis, the ALT in HA group was relative stable at 3 three measurements, before surgery, 24hrs and 48hrs after surergy, while the other 3 tests in HA group, compared with CON group, increased slowly and were lower at the same point, which suggested that, to some extent, HA-380 mitigated organic damage after TAAD surgery.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eOf note, there are also some limitations in this study. Firstly, this is a retrospective analysis from a single center, therefore, the sample size is relatively small and the bias may be not avoidable. Secondly, the number of observational variables is not comprehensive, especially, the assays for inflammatory factors are not determined. Thirdly, as a initial introduced device, besides connection with circuit of CPB, more time should be needed to explore the optimal usage of hemoadsorption.\u003c/em\u003e \u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003e \u003cem\u003eIn conclusion, HA380 hemoadsorptionis effective in improving short-term outcomes and protecting postoperative organic function after TAAD surgeries. In future, large multicenter studies are necessary to assess clinical significance of hemoadsorption and obtain more clear details about its usage in the field of cardiovascular surgery.\u003c/em\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eBing Liu is responsible for manuscript writing and study designing; Haiyuan Liu, Shuaipeng Zhang and Xue Wei are responsible for data collection; Shenglin Ge is responsible for manuscript reviewing.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analysed during this study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e1. Chukwu M, Ehsan P, Aburumman RN, et al. Acute Stanford Type A Aortic Dissection: A Review of Risk Factors and Outcomes. Cureus, 2023, 15(3):e36301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2. Hinoue T, Yatabe T, Nishida O. Prediction of postoperative atrial fibrillation with the systemic immune-inflammation index in patients undergoing cardiac surgery using cardiopulmonary bypass: a retrospective, single-center study. J Artif Organs, 2023, 26(2):112\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e3. Matejic-Spasic M, Lindstedt S, Lebreton G, et al. The role of hemoadsorption in cardiac surgery - a systematic review. BMC Cardiovasc Disord, 2024, 24(1):258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e4. Hawchar F, Tomescu D, Tr\u0026auml;ger K, et al. Hemoadsorption in the critically ill-Final results of the International CytoSorb Registry. PLoS One, 2022,17(10):e0274315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e5. Szigetv\u0026aacute;ry CE, Turan C, Kov\u0026aacute;cs EH, et al. Hemoadsorption as Adjuvant Therapy in Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis. Biomedicines, 2023, 11(11):3068.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e6. Geraci TC, Kon ZN, Moazami N, et al. Hemoadsorption for management of patients on veno-venous ECMO support for severe COVID-19 acute respiratory distress syndrome. J Card Surg, 2021, 36(11):4256\u0026ndash;4264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e7. Yang Y, Yang X, Yang J. Cholinesterase level is a predictor of systemic inflammatory response syndrome and complications after cardiopulmonary bypass. Ann Palliat Med, 2021, 10(11):11714\u0026ndash;11720.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e8. Diab M, Lehmann T, Bothe W, et al. Cytokine Hemoadsorption During Cardiac Surgery Versus Standard Surgical Care for Infective Endocarditis (REMOVE): Results From a Multicenter Randomized Controlled Trial. Circulation, 2022, 145(13):959\u0026ndash;968.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e9. Haidari Z, Demircioglu E, Boss K, et al. Intraoperative hemoadsorption in high-risk patients with infective endocarditis. PLoS One, 2022, 17(7):e0266820.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e10. Manohar M, Jawali V, Neginahal S, et al. Hemoadsorption in Complex Cardiac Surgery-A Single Center Experience. J Clin Med, 2022, 11(23):7005.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e11. Yang K, Huang H, Dai R, et al. Efficacy of Hemoperfusion Cartridge Procedure on Patients Undergoing Cardiac Valve Replacement Surgery with Cardiopulmonary Bypass. Heart Surg Forum, 2023, 26(1):E020-E026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e12. Pomar\u0026egrave; Montin D, Ankawi G, Lorenzin A, et al. Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion. Blood Purif, 2018, 46(3):187\u0026ndash;195.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e13. Ricci Z, Romagnoli S, Reis T, et al. Hemoperfusion in the intensive care unit. Intensive Care Med, 2022, 48(10):1397\u0026ndash;1408.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e14. Borazjani R, Mahmudi-Azer S, Taghrir MH, et al. Adjunctive hemoperfusion with Resin Hemoadsorption (HA) 330 cartridges improves outcomes in patients sustaining multiple Blunt Trauma: a prospective, quasi-experimental study. BMC Surg, 2023, 23(1):148.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e15. Surasit K, Srisawat N. The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study. Blood Purif, 2022, 51(11):879\u0026ndash;888.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e16. Nierhaus A, Morales J, Wendt D, et al. Comparison of the CytoSorb\u0026reg; 300 mL and Jafron HA380 hemoadsorption devices: an in vitro study. Minim Invasive Ther Allied Technol, 2022, 31(7):1058\u0026ndash;1065.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e17. Chen L, Zhou SL, Wang C, et al. Efficacy of HA380 hemoperfusion in the treatment of septic shock. J Transl Crit Care Med, 2024, 6:e24-00008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e18. Wang J, Chen B, Xie J, et al. Effects of Blood Hemoadsorption Therapy with HA-380 in Total Arch Replacement for Acute Type A Aortic Dissection: A Retrospective Observational Study. Blood Purif, 2024,53(2):138\u0026ndash;150.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stanford Type A aortic dissection, hemoadsorption, cardiopulmonary bypass","lastPublishedDoi":"10.21203/rs.3.rs-8353179/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8353179/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective To investigate the effect of hemoadsorption on short-term outcomes of patients with Stanford Type A Aortic Dissection.\u003c/p\u003e\n\u003cp\u003eMethod The clinical data of 100 patients with TAAD from January 2021 to June 2023 were retrospectively analyzed. Patients were divided into HA group and CON group, depending on the usage of hemoadsorption during the cardiopulmonary bypass, with 50 patients in each group. The comparison between two groups including surgery-related indicators such as cardiopulmonary time, surgery time, clamping time, Deep Hypothermia Cardiac Arrest time, ultrafiltration volume, urine output as well as blood transfusion and clinical laboratory tests such as white cell count, aspartate aminotransferase, alanine transaminase, creatinine as well as blood urea nitrogen. All these tests were measured before surgery, at 24hrs and 48hrs after surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults There was no significant difference for both baseline materials and surgery-related indicators between two groups (P\u0026gt;0.05). Compared with CON group, aspartate aminotransferase, alanine transaminase, creatinine and blood urea nitrogen in HA group improved, especially for alanine transaminase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion Hemoadsorption is valuable in improving and protecting liver and renal function within short-term period after TAAD surgery.\u003c/p\u003e","manuscriptTitle":"The effect of hemoadsorption to postoperative outcomes of patients with Stanford Type A Aortic Dissection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 10:10:12","doi":"10.21203/rs.3.rs-8353179/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-05T07:30:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T19:51:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T04:29:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T18:31:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T17:52:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T02:12:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176676054956133528902237008908735656998","date":"2026-02-05T11:28:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19313078723024528167242272097291379744","date":"2026-02-05T11:01:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227838295533428362572658217064371452141","date":"2026-02-05T08:38:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58755317992619796221698721244683935361","date":"2026-02-05T02:35:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T01:44:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17048839438403455279616146744616289691","date":"2026-02-03T11:31:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119723616181904565884166067358724136601","date":"2026-02-03T08:55:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293961133858662116739896960692631355643","date":"2026-02-03T08:55:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29665230460635874769780278358621177769","date":"2026-02-03T05:48:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T05:15:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T02:10:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T02:09:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-12-13T13:39:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02ddde5d-3d96-46d5-8db3-d1f3f1f0f303","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T16:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 10:10:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8353179","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8353179","identity":"rs-8353179","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}