{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:15:14Z","timestamp":1790043314397,"version":"4.0.1"},"reference-count":33,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Cardiopulmonary bypass (CPB) activates a well-characterised systemic inflammatory response that contributes substantially to postoperative morbidity and mortality, particularly in high-risk patient subgroups. CytoSorb\u00ae (CytoSorbents Corporation, Princeton, NJ) is a polystyrene-divinylbenzene copolymer haemoadsorption device capable of removing hydrophobic molecules of up to 55\u00a0kDa, including pro-inflammatory cytokines, myoglobin, bilirubin, and direct oral anticoagulants (DOACs) from whole blood during CPB. Whilst aggregate meta-analyses have not demonstrated consistent benefit across unselected surgical populations, subgroup analyses and targeted clinical series consistently identify meaningful benefit in high-risk phenotypes: infective endocarditis (IE), complex aortic surgery under hypothermic circulatory arrest, heart transplantation, emergency surgery in patients on antiplatelet or anticoagulant therapy, and patients developing vasoplegia or septic shock. This focused narrative review critically appraises the current evidence base, examines the mechanistic rationale, and proposes a clinically applicable patient-selection framework to guide rational integration of CytoSorb\u00ae into high-risk cardiac surgical practice. Regulatory considerations including the recent United States Food and Drug Administration (FDA) De Novo denial for the related DrugSorb-ATR device are discussed in context.<\/jats:p>","DOI":"10.1177\/02676591261452060","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:38:41Z","timestamp":1778769521000},"page":"829-836","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["CytoSorb\u00ae haemoadsorption in high-risk cardiac surgery: A focused review with proposed tiered patient selection"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-3358","authenticated-orcid":false,"given":"Sunil K.","family":"Ohri","sequence":"first","affiliation":[{"name":"University Hospital Southampton NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(01)01099-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200207000-00030"},{"key":"e_1_3_3_4_2","first-page":"10","article-title":"Comparative analysis of the systemic inflammatory response post cardiac surgery: the role of extracorporeal circulation","volume":"7","author":"Parissis H","year":"2012","unstructured":"Parissis H, Leotsinidis M, Hughes A, et al. Comparative analysis of the systemic inflammatory response post cardiac surgery: the role of extracorporeal circulation. J Cardiothorac Surg 2012; 7: 10.","journal-title":"J Cardiothorac Surg"},{"issue":"1","key":"e_1_3_3_5_2","first-page":"54","article-title":"Hemostatic abnormalities in patients undergoing cardiopulmonary bypass: pathophysiology, prevention and treatment","volume":"46","author":"Spiezia L","year":"2020","unstructured":"Spiezia L, Radu C, Rossetto V, et al. Hemostatic abnormalities in patients undergoing cardiopulmonary bypass: pathophysiology, prevention and treatment. Semin Thromb Hemost 2020; 46(1): 54\u201364.","journal-title":"Semin Thromb Hemost"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5464-6"},{"key":"e_1_3_3_7_2","first-page":"247","article-title":"Efficacy of CytoSorb\u00ae: a systematic review and meta-analysis","volume":"27","author":"Soukup P","year":"2023","unstructured":"Soukup P, Srinivasan M, Wendel-Garcia P, et al. Efficacy of CytoSorb\u00ae: a systematic review and meta-analysis. Crit Care 2023; 27: 247.","journal-title":"Crit Care"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/aas.14115"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000114997.39857.69"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0191676"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000688"},{"issue":"1","key":"e_1_3_3_12_2","first-page":"180","article-title":"Pharmacokinetics of anti-infective agents during CytoSorb hemoadsorption","volume":"25","author":"Schneider AG","year":"2021","unstructured":"Schneider AG, Andr\u00e9 P, Scheier J, et al. Pharmacokinetics of anti-infective agents during CytoSorb hemoadsorption. Crit Care 2021; 25(1): 180.","journal-title":"Crit Care"},{"key":"e_1_3_3_13_2","first-page":"264","article-title":"The role of hemoadsorption in cardiac surgery \u2014 a systematic review","volume":"24","author":"Haidari Z","year":"2024","unstructured":"Haidari Z, Demircioglu E, Boss K, et al. The role of hemoadsorption in cardiac surgery \u2014 a systematic review. BMC Cardiovasc Disord 2024; 24: 264.","journal-title":"BMC Cardiovasc Disord"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-05175-9"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.20630"},{"issue":"12","key":"e_1_3_3_16_2","first-page":"1610","article-title":"The effect of CytoSorb on inflammatory markers in critically ill patients: a systematic review and meta-analysis of randomized controlled trials","volume":"51","author":"Wieruszewski PM","year":"2023","unstructured":"Wieruszewski PM, Nei SD, Nelson S, et al. The effect of CytoSorb on inflammatory markers in critically ill patients: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 2023; 51(12): 1610\u20131619.","journal-title":"Crit Care Med"},{"issue":"11","key":"e_1_3_3_17_2","first-page":"1504","article-title":"Use of cytokine filters during cardiopulmonary bypass: systematic review and meta-analysis","volume":"31","author":"Gharehbaghi S","year":"2022","unstructured":"Gharehbaghi S, Yazdanfar S, Farrashzadeh M, et al. Use of cytokine filters during cardiopulmonary bypass: systematic review and meta-analysis. Heart Lung Circ 2022; 31(11): 1504\u20131513.","journal-title":"Heart Lung Circ"},{"key":"e_1_3_3_18_2","first-page":"105","article-title":"Hemoadsorption use in adult cardiac surgery for infective endocarditis: a comprehensive meta-analysis","volume":"33","author":"Dutta P","year":"2025","unstructured":"Dutta P, Ganduboina R, Muderrisoglu C, et al. Hemoadsorption use in adult cardiac surgery for infective endocarditis: a comprehensive meta-analysis. Perfusion 2025; 33: 105\u2013115. https:\/\/doi.org\/10.1177\/02184923251328119","journal-title":"Perfusion"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezae093"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0391398819831301"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10040564"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11143954"},{"issue":"4","key":"e_1_3_3_23_2","doi-asserted-by":"crossref","first-page":"e0266820","DOI":"10.1371\/journal.pone.0266820","article-title":"Intraoperative hemoadsorption in high-risk patients with infective endocarditis","volume":"17","author":"Haidari Z","year":"2022","unstructured":"Haidari Z, Demircioglu E, Boss K, et al. Intraoperative hemoadsorption in high-risk patients with infective endocarditis. PLoS One 2022; 17(4): e0266820. https:\/\/doi.org\/10.1371\/journal.pone.0266820","journal-title":"PLoS One"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.47363\/JCCEM\/2023(2)139"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2019.05.006"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/02676591241305276"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.5761\/atcs.oa.21-00154"},{"key":"e_1_3_3_28_2","first-page":"100165","article-title":"CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation","volume":"7","author":"Frering A","year":"2025","unstructured":"Frering A, Abi Lutfallah A, Carillion A, et al. CytoSorb hemoadsorption of apixaban during cardio-pulmonary bypass for heart transplantation. 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Management of perioperative bleeding risk in patients on antithrombotic medications undergoing cardiac surgery \u2014 interim analysis of the STAR Registry. J Thorac Cardiovasc Surg 2023; 165(3): 1000\u20131010.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"e_1_3_3_31_2","unstructured":"CytoSorbents Corporation. CytoSorbents updates US FDA regulatory status of DrugSorb-ATR [press release]. 2025. Available at: https:\/\/www.prnewswire.com\/news-releases\/cytosorbents-updates-us-fda-regulatory-status-of-drugsorb-atr-302534350.html. Accessed September 2025."},{"issue":"16","key":"e_1_3_3_32_2","first-page":"2310","article-title":"Hemoadsorption using CytoSorb\u00ae in patients with infective endocarditis: a German-based budget impact analysis","volume":"11","author":"Oberthuer R","year":"2023","unstructured":"Oberthuer R, Petrov M, Grosserichter-Wagener C, et al. Hemoadsorption using CytoSorb\u00ae in patients with infective endocarditis: a German-based budget impact analysis. 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