Effect of intraoperative haemoadsorption therapy on cardiac surgery for active infective endocarditis with confirmed Staphylococcus aureus bacteraemia. Issue 1 (27th January 2023)

• Record Type: Journal Article
• Authors: Haidari, Zaki; Leiler, Spela; Mamdooh, Hazem; Fittkau, Matthias; Boss, Kristina; Tyczynski, Bartosz; Thielmann, Matthias; Bagaev, Erik; El Gabry, Mohamed; Wendt, Daniel; Kribben, Andreas; Bertsch, Thomas; Ruhparwar, Arjang; Fischlein, Theodor; Kalisnik, Jurij Matija
• Is Part Of: Interdisciplinary cardiovascular and thoracic surgery. Volume 36:Issue 1(2023)
• Publication Date: 2023-01-27
• Subjects: Infective endocarditis -- Staphylococcus aureus -- Cardiac surgery -- Haemoadsorption -- Sepsis
• DOI: 10.1093/icvts/ivad010
• Languages: English
• ISSNs: 2753-670X

Abstract

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. Abstract : Postoperative sepsis followed by organ failure is an important cause of morbidity and mortality in patients undergoing cardiac surgery for infective endocarditis (IE) [1]. Staphylococcus aureus ( S. aureus ) is the leading cause of IE, and the significantly increased mortality rate has remained high despite increasingly effective diagnostic and therapeutic procedures [2, 3].