Whole Blood Adsorber During CPB and Need for Vasoactive Treatment After Valve Surgery in Acute Endocarditis: A Randomized Controlled Study

Objectives: Patients with endocarditis requiring urgent valvular surgery with cardiopulmonary bypass are at a high risk of developing systemic inflammatory response syndrome and septic shock, necessitating intensive use of vasopressors after surgery. The use of a cytokine hemoadsorber (CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac surgery has been suggested to reduce the risk of inflammatory activation. The study authors hypothesized that adding a cytokine adsorber would reduce cytokine burden, which would translate into improved hemodynamic stability. Design: A randomized, controlled, nonblinded clinical trial. Setting: At a university hospital, tertiary referral center. Participants: Nineteen patients with endocarditis undergoing valve surgery. Intervention: A cytokine hemoadsorber integrated into the cardiopulmonary bypass circuit. Measurements and Main Results: The accumulated norepinephrine dose in the intervention group was half or less at all postoperative time points compared to the control group, although it did not reach statistical significance; at 24 and 48 hours (median 36 [25-75 percentiles; 12-57] mu g v 114 [25-559] mu g, p = 0.11 and 36 [12-99] mu g v 261 [25-689] mu g, p = 0.09). There was no significant difference in chest tube output, but there was a significantly lower need for the transfusion of red blood cells (285 [0-657] mL v 1,940 [883-2,148] mL, p = 0.03). Conclusions: There was no statistically significant difference between the groups with regard to vasopressor use after surgery for endocarditis with the use of a cytokine hemoadsorber during cardiopulmonary bypass. Additional, larger randomized controlled trials are needed to definitely assess the potential effect. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study investigated the impact of using a cytokine hemoadsorber on hemodynamic stability in patients undergoing valve surgery for endocarditis. The results showed that the intervention group had a lower norepinephrine dose and significantly reduced need for red blood cell transfusions postoperatively compared to the control group.