Please select the eligibility criteria that correspond to the clinical trial below.
Title: Immunomodulatory Effect of Extracorporeal Cytokine Adsorption in Cardiac Surgery
Brief Summary: The modern era of cardiac surgery began in early 1950s with the introduction of cardiopulmonary bypass (CPB). Although it has been clearly shown that CPB is almost unavoidable for most open heart operations, an undesirable systemic inflammatory response syndrome (SIRS) is associated with its use. This complex chain of events has strong similarities with sepsis and may contribute to the development of postoperative complications and multiple organ failure (MOF). It has been shown that an excessive compensatory anti-inflammatory response (CARS) after SIRS can lead to immune paralysis and increased rate of hospital acquired infection. The balance of pro-inflammatory and anti-inflammatory mediators determines the inflammatory response and the clinical outcome. Accordingly, great efforts have been focused on therapeutic interventions aimed at reducing the inflammatory reactions during CPB, including pharmacologic strategies and modification of surgical techniques or mechanical devices. Such therapies may provide improvements in patient outcome after open heart operations. Among pharmacologic strategies is the prophylaxis with corticosteroids, which have been used during open heart surgery for more than 30 years. Many studies, both experimental and clinical, failed to produce evidence in favor of steroid treatment. As far as medical devices are concerned, the use of extracorporeal cytokine filter CytoSorb looks promising in cardiac surgery. It was recently approved by European Medicines Agency as an active treatment to fight cytokine storm.

Serum paraoxonase 1 (PON1) is a lipo-lactonase, being associated with HDL that has an anti-inflammatory role and protects against atherosclerosis. Low levels of PON1 are associated with venous graft occlusion in patients with coronary artery bypass grafting. PON1 reduces monocyte chemotaxis and adhesion to endothelial cells, leading to inhibition of the differentiation of monocytes into macrophages. The effects of cytokine adsorption therapy on PON1 are unknown.

The aim of the study is to explore the effects of extracorporeal immunoadsorption during CPB on pro-inflammatory and anti-inflammatory protective mediators and cellular immune status in cardiac surgery.


Options:
A: Inclusion Criteria:

* Valve replacement under cardiopulmonary bypass

Exclusion Criteria:

* Cardiopulmonary bypass time over 120 minutes
* Hyperlipidemia
* Diabetes mellitus
* Autoimmune diseases
B: Inclusion Criteria:

* Patients with coronary artery disease scheduled for elective CABG
* Patients willing and able to complete the requirements of this study
* Ejection Fraction \> 50%
* EuroSCORE ≤ 8
* men and women \>= 50 yrs
* women without childbearing potential
* ASA Score II-IV

Exclusion Criteria:

* Lack of informed consent
* EuroSCORE \< 8
* MMSE \< 24
* Age \< 50 years
* COPD GOLD \> II, increased need of oxygen
* Renal dysfunction
* Liver function disorders
* Acute coronary syndrome during the last 24 hours; hemodynamic instability
* Requirement of inotropic support
* Off-pump-surgery
* Disabling neuropsychiatric disorders
* History of stroke with residuals
* Hypersensitivity to the study anaesthetics
* Increased intracranial pressure
* Pregnancy and lactation period
* Women of childbearing potential
* Presumed uncooperativeness or legal incapacity
* Participation in a concomitant trial
C: Inclusion Criteria:

* Elective complex cardiac surgery (combined valve and coronary bypass grafting surgery, concomitant valve surgery, surgery of the ascending aorta and aortic arch, as well as re-operations of the same type)
* Age \> 18 years

Exclusion Criteria:

* Disagreement to participate in the study
* Age \< 18 years
* Pregnancy
* Emergency procedure
* Heart transplantation
* Implantation of LVAD (left ventricular assist device), RVAD (right ventricular assist device) or TAH (total artificial heart)
* Treatment with chemotherapy, immunosuppressive therapy
* Treatment with anti-leukocyte drugs or TNF-alfa blockers
* Immunocompromised patients (AIDS), leucopenia (\< 4,0x109 / L)
* Clinical and/or laboratory signs of infection (CRP \>2 mg/dl)
* Serum creatinine \>2 mg/dl
* Bilirubin \>2 mg/dl
* History of stroke
* Malnourished patients, BMI \< 18
D: Inclusion Criteria:

* Patients undergoing elective isolated coronary artery bypass surgery with on-pump technique
* Written informed consent

Exclusion Criteria:

* Concomitant valve or aortic surgery
* Left ventricular aneurysm repair
* Re-operation
* Emergency surgery
* History of myocardial infarction within less than 4 weeks
* Hepatic impairment
* Chronic renal impairment
* Drug related side effects (allergy or hypersensitivity)
* Familial Hyperlipidemia
* Autoimmune conditions which require steroids

Answer: C