Hemoadsorption treatment of patents with acute infectve endocardits during surgery with cardiopulmonary bypass – a case series
Abstract
Introducton:
Infective endocarditis is a serious disease condition. Depending on the causatve microorganism
and clinical symptoms͕ cardiac surgery and valve replacement may be needed͕ posing additonal risus to patents who may simultaneously suīer from septc shock. The combinaton of surgery bacterial spreadout and
artĮcial cardiopulmonary bypass (CPB) surfaces results in a release of Ŭey inŇammatory mediators leading to an
overshootng systemic hyperinŇammatory state freƋuently associated with compromised hemodynamic and organ functon. Hemoadsorpton might represent a potental approach to control the hyperinŇammatory systemic
reacton associated with the procedure itself and subseƋuent clinical conditons by reducing a broad range of
immuno-regulatory mediators.
Methods:
We describe 39 cardiac surgery patents with proven acute infectve endocardits obtaining valve replacement during CPB surgery in combinaton with intraoperatve CytoSorb hemoadsorpton. In comparison͕ we evaluated a historical group of 28 patents with infective endocarditis undergoing CPB surgery without intraoperatve hemoadsorption.
Results:
CytoSorb treatment was associated with a mitgated postoperatve response of key cytokines and
clinical metabolic parameters. Doreover͕ patents showed hemodynamic stability during and aŌer the operation while the need for vasopressors was less pronounced within hours aŌer completon of the procedure͕ which possibly could be atributed to the additonal CytoSorb treatment. Intraoperatve hemoperfusion treatment was well tolerated and safe without the occurrence of any CytoSorb device-related adverse event.
Conclusions:
Thus͕ this interventonal approach may open up potentally promising therapeutc optons for critcally-ill patents with acute infectve endocardits during and aŌer cardiac surgery͕ with cytokine reduction͕ improved hemodynamic stability and organ function as seen in our patents.
2017_Traegar_EndocarditisCaseSeries_IJAO_240_compressed