Zaki Haidari1, Daniel Wendt2, Matthias Thielmann2, Malwina Mackowiak3, Markus Neuhäuser3, Heinz Jakob2, Arjang Ruhparwar2, Mohamed El-Gabry2. 1. Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, University Hospital Essen, Essen, Germany. Electronic address: zaki.haidari@uk-essen.de. 2. Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, University Hospital Essen, Essen, Germany. 3. Department of Mathematics and Technique, Koblenz University of Applied Science, RheinAhrCampus Remagen, Remagen, Germany.
Abstract
BACKGROUND: Cardiac surgery in patients with infective endocarditis is associated with high mortality owing to postoperative septic multiorgan failure. Hemoadsorption therapy may improve surgical outcomes by reducing the circulating cytokines. We aimed to evaluate the clinical effects of intraoperative hemoadsorption in patients with mitral valve endocarditis. METHODS: Eligible candidates were patients with infective endocarditis of the native mitral valve undergoing cardiac surgery between January 2014 and July 2018. Patients with intraoperative hemoadsorption (hemoadsorption) were compared with surgery without hemoadsorption (control). The end points were the incidence of postoperative sepsis, sepsis-associated death, and 30-day mortality. Furthermore, postoperative need for epinephrine and norepinephrine and systemic vascular resistance were evaluated. RESULTS: A total of 58 consecutive patients were included: 30 in the hemoadsorption group and 28 in the control group. Postoperative sepsis occurred in 5 patients in the hemoadsorption group and in 11 in the control group (P = .05). No sepsis-associated death occurred in the hemoadsorption group, whereas 5 septic patients in the control group died (P = .02). Thirty-day mortality was 10% in the hemoadsorption group versus 18% in the control group (P = .39). On intensive care unit admission, the cumulative need for epinephrine and norepinephrine was 0.15 versus 0.24 μg/kg body weight/min (P = .01) and the median systemic vascular resistance was 1413 versus 1010 dyn·s·cm-5 (P = .02) in the hemoadsorption versus control group, respectively. CONCLUSIONS: Intraoperative hemoadsorption might reduce the incidence of postoperative sepsis and sepsis-related death. In addition, patients with intraoperative hemoadsorption showed greater hemodynamic stability. These data suggest that intraoperative hemoadsorption may improve surgical outcome in patients with mitral valve endocarditis.
BACKGROUND: Cardiac surgery in patients with infective endocarditis is associated with high mortality owing to postoperative septic multiorgan failure. Hemoadsorption therapy may improve surgical outcomes by reducing the circulating cytokines. We aimed to evaluate the clinical effects of intraoperative hemoadsorption in patients with mitral valve endocarditis. METHODS: Eligible candidates were patients with infective endocarditis of the native mitral valve undergoing cardiac surgery between January 2014 and July 2018. Patients with intraoperative hemoadsorption (hemoadsorption) were compared with surgery without hemoadsorption (control). The end points were the incidence of postoperative sepsis, sepsis-associated death, and 30-day mortality. Furthermore, postoperative need for epinephrine and norepinephrine and systemic vascular resistance were evaluated. RESULTS: A total of 58 consecutive patients were included: 30 in the hemoadsorption group and 28 in the control group. Postoperative sepsis occurred in 5 patients in the hemoadsorption group and in 11 in the control group (P = .05). No sepsis-associated death occurred in the hemoadsorption group, whereas 5 septic patients in the control group died (P = .02). Thirty-day mortality was 10% in the hemoadsorption group versus 18% in the control group (P = .39). On intensive care unit admission, the cumulative need for epinephrine and norepinephrine was 0.15 versus 0.24 μg/kg body weight/min (P = .01) and the median systemic vascular resistance was 1413 versus 1010 dyn·s·cm-5 (P = .02) in the hemoadsorption versus control group, respectively. CONCLUSIONS: Intraoperative hemoadsorption might reduce the incidence of postoperative sepsis and sepsis-related death. In addition, patients with intraoperative hemoadsorption showed greater hemodynamic stability. These data suggest that intraoperative hemoadsorption may improve surgical outcome in patients with mitral valve endocarditis.
Authors: David Santer; Jules Miazza; Luca Koechlin; Brigitta Gahl; Bejtush Rrahmani; Alexa Hollinger; Friedrich S Eckstein; Martin Siegemund; Oliver T Reuthebuch Journal: J Clin Med Date: 2021-02-03 Impact factor: 4.241
Authors: Jurij Matija Kalisnik; Spela Leiler; Hazem Mamdooh; Janez Zibert; Thomas Bertsch; Ferdinand Aurel Vogt; Erik Bagaev; Matthias Fittkau; Theodor Fischlein Journal: J Clin Med Date: 2022-07-07 Impact factor: 4.964