{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:42:37Z","timestamp":1792348957949,"version":"4.4.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"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"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Di(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in polyvinyl chloride medical devices employed during cardiopulmonary bypass (CPB). Although migration from these devices and blood-storage systems has long been recognized, the human clinical evidence remains limited and methodologically heterogeneous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative review used a structured search of PubMed\/MEDLINE, Scopus, and Google Scholar from database inception through 23 August 2026. Original peer-reviewed human clinical studies measuring parent DEHP or its metabolites in blood, plasma, or urine among patients undergoing CPB were eligible for the primary synthesis. Relevant mechanistic, biomaterial, transfusion-medicine, guideline, and regulatory sources were used for context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The searches identified 237 database records; 33 duplicates were removed, and 204 unique records were screened. Thirteen full-text reports were assessed, and seven human clinical studies published between 1983 and 2025 were included. Across adult and pediatric settings, perioperative increases in parent DEHP and\/or urinary or circulating metabolites were documented. The studies implicated multiple sources, including CPB components, blood-storage systems, and ancillary blood-contacting devices, but none provided complete patient-level source apportionment. DEHP-free tubing reduced, but did not eliminate, exposure. RBC washing reduced DEHP and MEHP in vitro, but a reduction in patient-level internal exposure has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Human clinical evidence consistently demonstrates internal exposure to DEHP or its metabolites during cardiac surgery involving CPB. However, small heterogeneous cohorts, variable analytes and sampling schedules, and limited outcome follow-up preclude causal inference regarding clinical harm. Prospective multicenter studies using standardized biomonitoring and source-apportionment methods are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261499217","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:15:01Z","timestamp":1792019701000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Di(2-ethylhexyl) phthalate (DEHP) exposure during cardiopulmonary bypass: A narrative review of human clinical evidence and future directions"],"prefix":"10.1177","author":[{"given":"Selwan Hamza","family":"Elgazzar","sequence":"first","affiliation":[{"name":"King Saud Medical City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin Moustafa","family":"Ayoub","sequence":"additional","affiliation":[{"name":"King Saud Medical City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed G.","family":"Elkhouly","sequence":"additional","affiliation":[{"name":"Tanta University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-7287","authenticated-orcid":false,"given":"Amr A.","family":"Arafat","sequence":"additional","affiliation":[{"name":"Tanta University"},{"name":"Prince Sultan Cardiac Center"},{"name":"Ministry of Defense Health Services"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43057-025-00154-4"},{"key":"e_1_3_4_3_2","first-page":"ivaf002","article-title":"2024 EACTS\/EACTAIC\/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery","volume":"40","author":"Wahba A","year":"2025","unstructured":"Wahba A, Kunst G, De Somer F, et al. 2024 EACTS\/EACTAIC\/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2025; 40: ivaf002. https:\/\/doi.org\/10.1093\/icvts\/ivaf002","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpharm.2015.08.033"},{"key":"e_1_3_4_5_2","volume-title":"Toxicological profile for di(2-ethylhexyl) phthalate (DEHP)","author":"Agency for Toxic Substances and Disease Registry","year":"2022","unstructured":"Agency for Toxic Substances and Disease Registry. Toxicological profile for di(2-ethylhexyl) phthalate (DEHP): US Department of Health and Human Services, 2022. Available at: https:\/\/www.atsdr.cdc.gov\/toxprofiles\/tp9.pdf (accessed 29 August 2026)."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0274(200101)39:1<100::AID-AJIM10>3.0.CO;2-Q"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2025.150904"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/021849230801600102"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/trf.17821"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)34493-9"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxlet.2020.04.004"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.06.035"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/198315245"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1289\/EHP15034"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.111.6.1467"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.113.5.e429"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2022.159994"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-55113-x"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.progpolymsci.2013.03.001"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2016.01.013"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2026.1830552"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261499217","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261499217","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261499217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:49:11Z","timestamp":1792345751000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261499217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,14]]},"references-count":20,"alternative-id":["10.1177\/02676591261499217"],"URL":"https:\/\/doi.org\/10.1177\/02676591261499217","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,14]]},"article-number":"02676591261499217"}}