Objectives Sepsis caused by infective endocarditis, due to staphylococcus aureus is associated with significant morbidity and mortality. Blood purification using hemoadsorption may attenuate the inflammatory response. We investigated the effect of intraoperative hemoadsorption on postoperative outcomes in staphylococcus aureus infective endocarditis. Methods Patients with confirmed staphylococcus aureus infective endocarditis undergoing cardiac surgery were included in a dual-center study between 01/2015 and 03/2022. Patients treated with intraoperative hemoadsorption (hemoadsorption group) were compared to patients not treated with hemoadsorption (control group). The primary outcome was vasoactive-inotropic score within the first 72 h postoperatively and secondary outcomes were sepsis-related mortality (SEPSIS-3 definition) and overall mortality at 30 and 90 days. Results No differences in baseline characteristics were observed between groups (hemoadsorption group, n = 75, control group, n = 55). Significantly decreased vasoactive-inotropic score was observed in the hemoadsorption group at all time points (6 h: 6.0(0–17) vs 17(3–47), p = 0.0014; 12 h: 2(0–8.3) vs 5.9(0–37), p = 0.0138; 24 h: 0(0–5) vs 4.9(0–23), p = 0.0064; 48 h: 0(0–2.1) vs 0.1(0–13), p = 0.0192; 72 h: 0(0) vs 0(0–5), p = 0.0014). Importantly, sepsis-related mortality (8.0% vs 22.8%, p = 0.02) as well as 30-day (17.3% vs 32.7%, p = 0.03) and 90-day overall mortality (21.3% vs 40%, p = 0.03) were also significantly lower with hemoadsorption. Conclusions Intraoperative HA during cardiac surgery for staphylococcus aureus infective endocarditis was associated with significantly lower postoperative vasopressor and inotropic requirements and resulted in lower sepsis-related and overall 30- and 90-day mortality. In this high-risk population, improved postoperative haemodynamic stabilization by intraoperative hemoadsorption appears to improve survival and should be further tested in future randomized trials.

Background: Cardiac surgery in patients with infective endocarditis (IE) is still associated with high mortality and morbidity; an already present inflammation might further be aggravated due to a cardiopulmonary bypass-induced dysregulated immune response. Intraoperative hemoadsorption therapy may attenuate this septic response. Our objective was therefore to assess the efficacy of intraoperative hemoadsorption in active left-sided native- and prosthetic infective endocarditis. Methods: Consecutive high-risk patients with active left-sided infective endocarditis were enrolled between January 2015 and April 2021. Patients with intraoperative hemoadsorption (Cytosorbents, Princeton, NJ, USA) were compared to patients without hemoadsorption (control). Endpoints were the incidence of postoperative sepsis, sepsis-associated death and in-hospital mortality. Predictors for sepsis-associated mortality and in-hospital mortality were analysed by multivariable logistic regression. Results: A total of 202 patients were included, 135 with active left-sided native and 67 with prosthetic valve infective endocarditis. Ninety-nine patients received intraoperative hemoadsorption and 103 patients did not. Ninety-nine propensity-matched pairs were selected for final analyses. Postoperative sepsis and sepsis-related mortality was reduced in the hemoadsorption group (22.2% vs. 39.4%, p = 0.014 and 8.1% vs. 22.2%, p = 0.01, respectively). In-hospital mortality tended to be lower in the hemoadsorption group (14.1% vs. 26.3%, p = 0.052). Key predictors for sepsis-associated mortality and in-hospital mortality were preoperative inotropic support, lactate-levels 24 h after surgery, C-reactive protein levels on postoperative day 1, chest tube output, cumulative inotropes and white blood cell counts on postoperative day 2, and new onset of dialysis. Multivariate regression analysis revealed intraoperative hemoadsorption to be associated with lower sepsis-associated (OR 0.09, 95% CI 0.013–0.62, p = 0.014) as well as in-hospital mortality (OR 0.069, 95% CI 0.006–0.795, p = 0.032). Conclusions: Intraoperative hemoadsorption holds promise to reduce sepsis and sepsis-associated mortality after cardiac surgery for active left-sided native and prosthetic valve infective endocarditis.

Objectives Aortic valve replacement with a sutureless prosthesis (Su-AVR) is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. Methods All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our center between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. Results Study population consisted of 547 patients: mean age was 76.4 (5.2) years, 51% were female, and mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years (95% CI = 6.9–8.6). Risk factor analysis identified age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.11; p < 0.001), EuroSCORE II (HR 1.08, 1.02–1.13; p < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4–4.4; p = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58–17.6; p < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per one year and for EuroSCORE II is one percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of which 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82–0.95; p < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. Conclusions The sutureless valve represents a reliable bioprosthesis for AVR in patients with a 10-year life expectancy. Younger age at time of implant is the only factor associated with the risk of long-term SVD.

No abstract

No abstract