Dataset Information

Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study.

ABSTRACT: Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb® hemoadsorption (HA) device during cardiopulmonary bypass. From 2009 until 2019, 241 patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery (n = 41) versus patients without HA (n = 200), after applying inverse probability of treatment weighting. In-hospital mortality, major adverse cardiac and cerebrovascular events and postoperative renal failure were similar in both groups. Demand for norepinephrine (88.4 vs. 52.8%; p = 0.001), milrinone (42.2 vs. 17.2%; p = 0.046), red blood cell concentrates (65.2 vs. 30.6%; p = 0.003), and platelets (HA vs. Control: 36.7 vs. 9.8%; p = 0.013) were higher in the HA group. In addition, a higher incidence of reoperation for bleeding (34.0 vs. 7.7 %; p = 0.011), and a prolonged length of in-hospital stay (15.2 (11.8 to 19.6) vs. 9.0 (7.1 to 11.3) days; p = 0.017) were observed in the HA group. No benefits of HA-therapy were observed in patients with infective endocarditis undergoing valve surgery.

SUBMITTER: Santer D

PROVIDER: S-EPMC7913197 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study.

Santer David D Miazza Jules J Koechlin Luca L Gahl Brigitta B Rrahmani Bejtush B Hollinger Alexa A Eckstein Friedrich S FS Siegemund Martin M Reuthebuch Oliver T OT

Journal of clinical medicine 20210203 4

<h4>Background</h4>Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb<sup>®</sup> hemoadsorption (HA) device during cardiopulmonary bypass.<h4>Methods</h4>From 2009 until 2019, 241 patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery (<i>n</i> = 41) versus patients without HA (<i>n</i> = 200), after applying in ...[more]

PMID: 33546164

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Project description:BackgroundCardiopulmonary bypass (CPB) surgery initiates a systemic inflammatory response, which is associated with postoperative morbidity and mortality. Hemoadsorption (HA) of cytokines may suppress inflammatory responses and improve outcomes. We tested a new sorbent used for HA (CytoSorb™; CytoSorbents Europe GmbH, Berlin, Germany) installed in the CPB circuit on changes of pro- and anti-inflammatory cytokines levels, inflammation markers, and differences in patients' perioperative course.MethodsIn this first pilot trial, 37 blinded patients were undergoing elective CPB surgery at the Medical University of Vienna and were randomly assigned to HA (n = 19) or control group (n = 18). The primary outcome was differences of cytokine levels (IL-1β, IL-6, IL-18, TNF-α, and IL-10) within the first five postoperative days. We also analyzed whether we can observe any differences in ex vivo lipopolysaccharide (LPS)-induced TNF-α production, a reduction of high-mobility box group 1 (HMGB1), or other inflammatory markers. Additionally, measurements for fluid components, blood products, catecholamine treatment, bioelectrical impedance analysis (BIA), and 30-day mortality were analyzed.ResultsWe did not find differences in our primary outcome immediately following the HA treatment, although we observed differences for IL-10 24 hours after CPB (HA: median 0.3, interquartile range (IQR) 0-4.5; control: not traceable, P = 0.0347) and 48 hours after CPB (median 0, IQR 0-1.2 versus not traceable, P = 0.0185). We did not find any differences for IL-6 between both groups, and other cytokines were rarely expressed. We found differences in pretreatment levels of HMGB1 (HA: median 0, IQR 0-28.1; control: median 48.6, IQR 12.7-597.3, P = 0.02083) but no significant changes to post-treatment levels. No differences in inflammatory markers, fluid administration, blood substitution, catecholamines, BIA, or 30-day mortality were found.ConclusionsWe did not find any reduction of the pro-inflammatory response in our patients and therefore no changes in their perioperative course. However, IL-10 showed a longer-lasting anti-inflammatory effect. The clinical impact of prolonged IL-10 needs further evaluation. We also observed strong inter-individual differences in cytokine levels; therefore, patients with an exaggerated inflammatory response to CPB need to be identified. The implementation of HA during CPB was feasible.Trial registrationClinicalTrials.gov: NCT01879176, registration date: June 7, 2013.

Project description:ObjectiveThe objective of this study was to improve long-term postoperative survival in a porcine cardiac valve surgery model by utilizing cardiopulmonary bypass (CPB) via left thoracotomy. The study aimed to share refined techniques and insights accumulated over years at a single-center animal clinical trial facility.MethodA total of 196 Chinese Large White pigs weighing between 60 and 75 kg were used in the study. All animals underwent cardiac valve surgeries via left thoracotomy with CPB. Surgical techniques included mitral valve replacement, mitral valve repair, aortic valve replacement, OZAKI procedure, ascending aorta replacement, and left ventricular assist device implantation. Anesthesia and CPB protocols were optimized to minimize stress and complications. Postoperative care was standardized to enhance recovery and survival.ResultAll 196 pigs survived the surgical procedures, with no deaths reported. The mean surgical duration was 168.55 ± 38.75 min, CPB time was 114.89 ± 32.11 min, and aortic cross-clamp time was 76.75 ± 21.33 min. Automatic heart resumption occurred in 63.8% of pigs, while the remainder required electrical defibrillation or cardiac massage. The postoperative mechanical ventilation time was 2.44 ± 0.58 min, and the average drainage volume at 2 h postoperatively was 27.50 ± 9.70 ml. There were no cases of postoperative hemorrhage complications or blood transfusions, and surgical site infections occurred in only 1.5% of pigs.ConclusionThe surgical approach utilizing left thoracotomy with CPB has proven effective in significantly enhancing long-term survival rates in porcine heart surgeries. The refined techniques and standardized operational procedures described in this study offer valuable insights for researchers aiming to improve the success of porcine heart valve surgical models. However, due to differences in animal anatomy, the applicability of this surgical approach to other animal models still requires further exploration.

Dataset Information

Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study.

Publications

Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study.

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