Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study

Abstract

Background: Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb® hemoadsorption (HA) device during cardiopulmonary bypass. Methods: From 2009 until 2019, 241 patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery (n = 41) versus patients without HA (n = 200), after applying inverse probability of treatment weighting. Results: In-hospital mortality, major adverse cardiac and cerebrovascular events and postoperative renal failure were similar in both groups. Demand for norepinephrine (88.4 vs. 52.8%; p = 0.001), milrinone (42.2 vs. 17.2%; p = 0.046), red blood cell concentrates (65.2 vs. 30.6%; p = 0.003), and platelets (HA vs. Control: 36.7 vs. 9.8%; p = 0.013) were higher in the HA group. In addition, a higher incidence of reoperation for bleeding (34.0 vs. 7.7 %; p = 0.011), and a prolonged length of in-hospital stay (15.2 (11.8 to 19.6) vs. 9.0 (7.1 to 11.3) days; p = 0.017) were observed in the HA group. Conclusions: No benefits of HA-therapy were observed in patients with infective endocarditis undergoing valve surgery.

The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

“…Out of the 163 clinical articles available in PubMed, 58 were identified that mentioned "catecholamines and/or vasopressors". In total, 25 papers were excluded; 12 because of non-comparability of the measurement scales [25][26][27][28][29][30][31][32][33][34][35][36]; 4 because the type and dose of vasopressors were not specified [37][38][39][40]; 1 that reported combined norepinephrine and epinephrine doses [41]; 1 that only reported on patients that had survived [42]; and 7 where there were no measurements pre-and post-adsorber use in the same patient [43][44][45][46][47][48][49]. The remaining 33 articles were summarized without considering different study designs or duration of treatment.…”

Application of Adsorptive Blood Purification Techniques during Cardiopulmonary Bypass in Cardiac Surgery

“…The valve surgery mentioned in the above elective heart surgery did not indicate whether they were performed for infective endocarditis or for other reasons, and one study [ 70 ] even directly excluded patients with infective endocarditis. There were five studies involving only patients with infective endocarditis, including one RCT [ 77 ], two retrospective studies [ 78 , 79 ], and two case series [ 80 , 81 ].…”

“…Neither of the two retrospective studies could obtain cytokine values, but according to the analysis of infection indicators, Haidari et al [ 78 ] found that there was no significant difference among CRP, PCT, and WBC levels, but the recovery rate of these three parameters was significantly accelerated in the hemadsorption group. Santer et al [ 79 ] found that the WBC counts of patients treated with hemadsorption decreased significantly in the first five days after operation. The other two case series did not focus on this outcome.…”

“…In the RCT study [ 77 ], the hemadsorption (HA) group had higher catecholamine and fluid requirements in the early postoperative period. Three observational studies [ 78 , 80 , 81 ] all suggested that the HA group had better hemodynamic stability, while only Santer et al [ 79 ] observed that the HA group had significantly increased demand for norepinephrine, milrinone, erythrocyte concentrate, platelets, and FFP.…”

A New Tool in the Management of Direct-Acting Oral Anticoagulants in Emergency Cardiac Surgery

“…Of note, more recent studies have found no clinical benefits of CytoSorb ® HA therapy in patients with infective endocarditis undergoing mitral and aortic valve surgery. 25,26 Further, CytoSorb ® HA has been suggested to reduce plasma-free hemoglobin during prolonged CPB runs, 27 to remove bilirubin in cardiac surgery patients with hepatic failure, 28 and to rapidly remove non-dialyzable drugs with a high degree of protein binding from blood in vivo. 29 In addition, CytoSorb ® HA might remove several anticoagulant drugs such as ticagrelor and DOACs including rivaroxaban, apixaban, and edoxaban while preserving coagulation factors and proteins.…”