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. 2025 Mar 28;12(4):119.
doi: 10.3390/jcdd12040119.

Intraoperative Hemoadsorption in Heart Transplant Surgery: A 5-Year Experience

Nikola Sliskovic  1 , Gloria Sestan  1 , Savica Gjorgjievska  1 , Davor Baric  1 , Daniel Unic  1 , Josip Varvodic  1 , Marko Kusurin  1 , Dubravka Susnjar  1 , Sarah Singer  1 , Igor Rudez  1
Affiliations

Intraoperative Hemoadsorption in Heart Transplant Surgery: A 5-Year Experience

Nikola Sliskovic et al. J Cardiovasc Dev Dis. .

Abstract

Background: Hyperimmune response and cytokine release post-reperfusion might occur after orthotopic heart transplantation (HTx). Intraoperative hemoadsorption (HA) has been introduced to remove such elevated cytokines. We aimed to analyze the effect of intraoperative HA in patients undergoing orthotopic HTx.

Methods: Between 2018 and 2022, 40 consecutive orthotopic HTx patients who underwent intraoperative hemoadsorption HA integrated into the cardiopulmonary bypass were compared to 41 historical controls. Primary outcome measures included postoperative hemodynamic stability and blood product requirements, while secondary outcomes were the incidence of acute kidney injury requiring dialysis (AKI-d) and 30-day mortality.

Results: Postoperatively, the vasoactive-inotropic score (VIS) did not significantly differ between the groups. However, the use duration for milrinone and dobutamine was shortened by one day compared to controls. The HA group had fewer red blood cell transfusions (765 vs. 1330 mL, p = 0.01) and lower fresh frozen plasma requirements (945 vs. 1200 mL, p = 0.04). Mechanical ventilation duration was reduced (22 vs. 28 h, p = 0.02). AKI-d rates were similar, and 30-day mortality favored non-significantly the HA group (5% vs. 14.6%, p = ns). No device-related adverse events were observed.

Conclusion: These findings suggest that intraoperative HA might improve immediate postoperative outcomes; however, further validation in larger randomized controlled trials is warranted.

Keywords: CytoSorb; cardiac surgery; cytokines; heart transplantation; hemoadsorption.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Adsorption properties of polymer beads in CytoSorb®.
Figure 2
Figure 2
Adjunctive CytoSorb® hemoadsorption device installed into the CPB circuit.
Figure 3
Figure 3
Vasoactive support in the immediate postoperative period (within the first 6 h).
Figure 4
Figure 4
Postoperative vasoactive therapy duration.
Figure 5
Figure 5
Blood product consumption.
Figure 6
Figure 6
Mortality rates.
See this image and copyright information in PMC

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