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. 2023 Jan 4;36(1):ivad010.
doi: 10.1093/icvts/ivad010.

Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmed Staphylococcus aureus bacteraemia

Zaki Haidari  1 , Spela Leiler  2 , Hazem Mamdooh  2 , Matthias Fittkau  2 , Kristina Boss  3 , Bartosz Tyczynski  3 , Matthias Thielmann  1 , Erik Bagaev  2 , Mohamed El Gabry  1 , Daniel Wendt  1   4 , Andreas Kribben  3 , Thomas Bertsch  5 , Arjang Ruhparwar  1 , Theodor Fischlein  2 , Jurij Matija Kalisnik  2
Affiliations

Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmed Staphylococcus aureus bacteraemia

Zaki Haidari et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Sepsis caused by infective endocarditis (IE), due to Staphylococcus aureus, is associated with significant morbidity and mortality. Blood purification using haemoadsorption (HA) may attenuate the inflammatory response. We investigated the effect of intraoperative HA on postoperative outcomes in S. aureus IE.

Methods: Patients with confirmed S. aureus IE undergoing cardiac surgery were included in a dual-centre study between January 2015 and March 2022. Patients treated with intraoperative HA (HA group) were compared to patients not treated with HA (control group). The primary outcome was vasoactive-inotropic score within the first 72 h postoperatively and secondary outcomes were sepsis-related mortality (SEPSIS-3 definition) and overall mortality at 30 and 90 days.

Results: No differences in baseline characteristics were observed between groups (haemoadsorption group, n = 75, control group, n = 55). Significantly decreased vasoactive-inotropic score was observed in the haemoadsorption group at all time points [6 h: 6.0 (0-17) vs 17 (3-47), P = 0.0014; 12 h: 2 (0-8.3) vs 5.9 (0-37), P = 0.0138; 24 h: 0 (0-5) vs 4.9 (0-23), P = 0.0064; 48 h: 0 (0-2.1) vs 0.1 (0-13), P = 0.0192; 72 h: 0 (0) vs 0 (0-5), P = 0.0014]. Importantly, sepsis-related mortality (8.0% vs 22.8%, P = 0.02) and 30-day (17.3% vs 32.7%, P = 0.03) and 90-day overall mortality (21.3% vs 40%, P = 0.03) were also significantly lower with haemoadsorption.

Conclusions: Intraoperative HA during cardiac surgery for S. aureus IE was associated with significantly lower postoperative vasopressor and inotropic requirements and resulted in lower sepsis-related and overall 30- and 90-day mortality. In this high-risk population, improved postoperative haemodynamic stabilization by intraoperative HA appears to improve survival and should be further tested in future randomized trials.

Keywords: Staphylococcus aureus; Cardiac surgery; Haemoadsorption; Infective endocarditis; Sepsis.

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Figures

Figure 1:
Figure 1:
(A) Spectrum of adsorption and (B) haemoadsorption device (CytoSorbents, Princeton, NJ, USA).
Figure 2:
Figure 2:
Box plot illustration of the vasoactive-inotropic score during the postoperative course.
Figure 3:
Figure 3:
SOFA score during the postoperative course. SOFA: Sequential Organ Failure Assessment.
None
See this image and copyright information in PMC

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