Hemoadsorption in Complex Cardiac Surgery—A Single Center Experience

Abstract

(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb®. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb® were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb® (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, p = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group (p = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb® hemoadsorption in complex cardiac surgery and a trend of lower mortality.

The role of hemoadsorption in cardiac surgery – a systematic review

“…The search yielded 10 articles reporting on studies that enrolled patients undergoing elective, but complex cardiac surgical procedures (Table 2 ). Eight of the 10 studies were RCTs, six original and two post hoc subgroup analyses from the oldest RCT in this group from Bernardi et al [ 15 ], while the remaining two studies were a prospective case series [ 16 ], and a retrospective comparative study [ 17 ]. The total cohort of this subgroup comprised 109 patients treated with hemoadsorption and 131 controls (subjects from post hoc analyses excluded) in the period 2016–2022.…”

“…Procedures included open valve surgery, coronary artery bypass grafting (CABG)—isolated and combined [ 15 , 18 , 19 , 24 ], or various other cardiac surgery operations with prolonged CPB times (> 90 min) [ 16 , 17 , 20 , 21 , 23 ], including one study that enrolled patients who underwent combined aortic root and valve surgery [ 22 ]. Hemoadsorption was used exclusively intraoperatively in all studies, however in one study two adsorbers in parallel connection within the CPB circuit were used [ 20 ].…”

Impact of intraoperative haemoadsorption on outcomes of patients undergoing aortic surgery: a single-centre, prospective, observational study

“…There was significant reduction of the VIS after 48 h of treatment as compared to baseline (20 vs 10, P = 0.009). In a recent, observational study of patients undergoing complex cardiac surgery, Manohar et al showed lower VIS in the HA group (HA: 3.5 vs C: 5.5, P = 0.05) compared to controls [ 17 ].…”

Redo Bentall Procedure in a Marfan Syndrome Patient with COVID-19, Treated with Extracorporeal Cytokine Hemoadsorption

“…In addition, the high-risk nature of this patient, as indicated by the high EuroSCORE, the need for redo aortic surgery, the physiological and inflammatory stresses associated with the cardio-pulmonary bypass, an anticipated prolonged cardiopulmonary bypass duration, and the fact that it was an emergency, made it a suitable case for the use of the CytoSorb adsorber. In this regard, there is a good body of evidence on the beneficial prophylactic use of intraoperative CytoSorb hemoadsorption in patients undergoing invasive high-risk cardiothoracic procedures [ 11 , 20 – 23 ]. Besides other effects, these studies show an attenuation in the severity of postoperative sepsis [ 20 ], improved lung function and shortened duration of ventilator use411,21], mitigated inflammatory response [24], accelerated recovery of multiorgan and microcirculatory dysfunction [ 22 ], improved hemodynamic stability [ 23 ], and reduced sepsis-associated mortality [ 20 , 23 ].…”