Hemoadsorption Treatment of Patients with Acute Infective Endocarditis during Surgery with Cardiopulmonary Bypass - A Case Series

Abstract

IntroductionInfective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function. Hemoadsorption might represent a potential approach to control the hyperinflammatory systemic reaction associated with the procedure itself and subsequent clinical conditions by reducing a broad range of immuno-regulatory mediators.MethodsWe describe 39 cardiac surgery patients with proven acute infective endocarditis obtaining valve replacement during CPB surgery in combination with intraoperative CytoSorb hemoadsorption. In comparison, we evaluated a historical group of 28 patients with infective endocarditis undergoing CPB surgery without intraoperative hemoadsorption.ResultsCytoSorb treatment was associated with a mitigated postoperative response of key cytokines and clinical metabolic parameters. Moreover, patients showed hemodynamic stability during and after the operation while the need for vasopressors was less pronounced within hours after completion of the procedure, which possibly could be attributed to the additional CytoSorb treatment. Intraoperative hemoperfusion treatment was well tolerated and safe without the occurrence of any CytoSorb device-related adverse event.ConclusionsThus, this interventional approach may open up potentially promising therapeutic options for critically-ill patients with acute infective endocarditis during and after cardiac surgery, with cytokine reduction, improved hemodynamic stability and organ function as seen in our patients.

Acute Kidney Injury Associated with Cardiac Surgery: a Comprehensive Literature Review

“…On the other hand, studies have also suggested that the use of colloids is the best strategy to maintain intravascular volume and haemodynamic stability. Paradoxically, studies also advise fluid restricting patients, as Stewart et al have previously demonstrated a reduction in ICU stay and more ventilator-free days in cardiac surgery patients who underwent conservative fluid management [49] .…”

Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series

“…A recently published prospective single-center study by Friesecke and coworkers in twenty patients with septic shock refractory to standard treatment that were treated with CytoSorb showed a significant reduction in norepinephrine dosages and shock reversal in two thirds of the patients [19]. Likewise, patients undergoing cardiopulmonary bypass-assisted cardiac surgery (including those with endocarditis) who developed post-operative hyperinflammation, showed a marked benefit from hemoadsorption treatment in terms of hemodynamic stabilization and reduction in catecholamine dosages [2,20].…”

Applications of Cytosorb in clinical practice

“…3]. Less vasopressor was needed during the operation, and fewer renal replacement therapy implemented after the surgery in patients who used Cytosorb connected to the cardiopulmonary by-pass [23,24]. In a study performed by Gleason et al, patients with haemoadsorption had a significantly lower free haemoglobin and activated complement serum concentrations [25].…”