Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmedStaphylococcus aureusbacteraemia

Abstract

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.

The role of hemoadsorption in cardiac surgery – a systematic review

“…Notwithstanding, based on the results of studies presented here, it seems that hemoadsorption may improve outcomes in high-risk IE patients (5,7,9,11,12,45). This is supported by the high baseline risk scores (EuroSCORE-II > 8%) (51) in the studies that reported benefit with hemoadsorption.…”

The role of hemoadsorption in cardiac surgery – a systematic review

“…The benefit of non-selective depletion of cytokines has not yet been proven in this population of patients. Notwithstanding, based on the results of studies presented here, it seems that hemoadsorption may improve outcomes in high-risk IE patients [ 5 , 6 , 11 – 14 ]. This is supported by the high baseline risk scores (EuroSCORE-II > 8%) [ 51 ] in the studies that reported benefit with hemoadsorption.…”

“…The most frequently reported outcome was vasopressor requirements, and in all but two studies [ 10 , 13 ], a significant reduction (where statistical analysis was performed) in vasopressor drug demand was observed with intraoperative hemoadsorption. Cytokine reductions with CytoSorb ® were confirmed in two studies [ 5 , 10 ], while significantly lower postoperative sepsis-related mortality with hemoadsorption was observed in four studies [ 7 , 11 , 13 , 14 ]. Out of these four, one recent study showed a significantly reduced 30- and 90-day mortality in selected patients suffering from Staphylococcus aureus -derived infective endocarditis [ 14 ].…”

“…Cytokine reductions with CytoSorb ® were confirmed in two studies [ 5 , 10 ], while significantly lower postoperative sepsis-related mortality with hemoadsorption was observed in four studies [ 7 , 11 , 13 , 14 ]. Out of these four, one recent study showed a significantly reduced 30- and 90-day mortality in selected patients suffering from Staphylococcus aureus -derived infective endocarditis [ 14 ].…”

“…aureus has increased in recent years [ 48 ], introducing even more complexity and risk within this field. This sub-population of IE patients was investigated explicitly in a recent dual-center study in which the use of hemoadsorption was associated with significantly lower VIS, incidence of renal failure requiring dialysis, and fewer deaths (sepsis-related, 30-day, and 90-day mortality) [ 14 ]. In addition, certain bacteria toxins may also be removed by CytoSorb ® [ 45 ], specifically Staph.…”