Hemoadsorption use in adult cardiac surgery for infective endocarditis: A comprehensive meta-analysis

Abstract

IntroductionInfective endocarditis (IE) is a severe infection of the endocardium, primarily affecting the heart valves, exhibiting high morbidity and mortality rates. Cardiac surgery for IE with cardiopulmonary bypass (CPB) can further exacerbate the inflammatory response and cytokine production from IE. The current meta-analysis evaluates the use of CytoSorb^® hemoadsorption in IE patients undergoing cardiac surgery to determine its efficacy in reducing inflammatory mediators and improving clinical outcomes.MethodsPubMed, Cochrane, Google Scholar, Clinical Trials, and Google Scholar were searched for articles until July 2024. After performing a risk of bias and quality assessment, data on operative times, mortality, and morbidity were extracted for meta-analysis. Statistical Software R (version 4.4.0) was used to calculate odds ratio (OR) and standardized mean differences using a random-effect model with a 95% confidence interval (CI) and p-value less than 0.05.ResultsEight studies, encompassing 1076 patients, were included in the analysis. These comprised three randomized controlled trials and five nonrandomized studies. The majority of these studies exhibited some concerns regarding bias. Hemoadsorption group showed lower discharge mortality (OR: 0.58, 95% CI: 0.33-1.00, p = 0.05) compared to controls, but no significant disparity is observed in other outcomes. In-hospital outcomes also showed higher heterogeneity, with an I² value greater than 50%.ConclusionCytoSorb use in patients undergoing cardiac surgery with CPB used for IE has no impact on operative mortality and morbidity but has a beneficial effect on discharge mortality.

Keywords: CytoSorb; Hemadsorption; cardiopulmonary bypass; cytokines; infective endocarditis.