3 . 2023

Hemadsorption in infectious endocarditis requiring open heart surgery

Abstract

Infectious endocarditis (IE) is associated with a high mortality rate, excessive systemic hyperinflammatory response or sepsis. Treatment of severe IE involves a combination of surgical intervention and antibiotics. However, traditional therapy may not be sufficient to control the infection. Recently, hemadsorption is a promising therapy to treat patients with sepsis. This method has been increasingly used to prevent septic complications after cardiac surgery. Hemadsorption (HA) has been proposed as adjunctive therapy for IE, but its efficacy remains unclear.

We conducted our own research investigating the effects of prolonged hemadsorption therapy on the concentration of inflammatory markers in patients operated for IE in the early postoperative period comparing CytoSorb-300 with HA-330 adsorbers. As the results are preliminary, we performed a literature review to match the data and to cover questions about the effectiveness and safety of hemadsorption therapy for patients after cardiac surgery due to infective endocarditis.

Aim. To assess the safety and efficacy of prolonged hemadsorption therapy for patients with IE undergoing open-heart surgery.

Material and methods. We conducted comprehensive computerized literature research to identify studies analyzing HA therapy for IE using MEDLINE and, involving both medical subject heading (MeSH) terminology and relevant keywords for search strings. The following items were used to search for the studies: “hemadsorption,” “infective endocarditis”, “infectious endocarditis,” and “open heart surgery.” We performed this research to cover questions about the effectiveness and safety of hemadsorption therapy. Furthermore, data from our study investigates the effect of perioperative HA therapy on inflammatory parameters and hemodynamic status in the patients operated on for IE. The patients were included into CytoSorb-300, or Jafron HA-330 HA therapy, or the control group. The HA therapy was initiated intraoperatively and continued for 72 hours postoperatively.

Results. Between January 2021, and April 2022, a total of 39 patients were randomly assigned to hemadsorption or control groups. Three patients were excluded because they were unable to sign an informed consent form thus, 36 patients were enrolled in the study: CytoSorb-300 (n=12), HA-330 (n=13), control group (n=11). Length of stay in the intensive care unit (p=0.6), the duration of mechanical ventilation (p=0.57), as well as the number of complications such as significant bleeding (p=1), ischemic stroke (p=0.53), delirium (p=0.78) did not differ between the groups. A statistically significant difference was found in the level of IL-10 (p<0.01), IL-8 24 hours after surgery (p=0.04) and CRP (p<0.01).

When comparing cytokine filters and control across all studies there was no significant difference in operative mortality, ventilation duration, hospital stay and ICU length of stay.

Conclusion. The use of HA procedures intraoperatively and in the postoperative period has an impact on the reduction of the inflammatory markers concentration. We believe that HA therapy may be beneficial for patients with IE and a high risk of sepsis.

Keywords:hemadsorption; infective endocarditis; cardiac surgery

Funding. This research is funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant N BR 10965200, AP 09258870).

Conflict of interest. The authors declare no conflict of interest.

For citation: Kuanyshbek A.S., Lesbekov T.D., Bekishev B.E., Kaliev R.B., Jabayeva N.A., Faizov L.R. Hemadsorption in infectious endocarditis requiring open heart surgery. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (3): 116–25. DOI: https://doi.org/10.33029/2308-1198-2023-11-3-116-125

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