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The effect of perioperative hemadsorption in patients operated for acute infective endocarditis - A randomized, controlled study.

OBJECTIVES
Patients operated for infective endocarditis (IE) are at high risk of developing an excessive systemic hyper-inflammatory state, resulting in systemic inflammatory response syndrome (SIRS) and septic shock. Hemadsorption (HA) by cytokine adsorbers has been successfully applied to remove inflammatory mediators. This randomized controlled trial investigates the effect of perioperative HA therapy on inflammatory parameters and hemodynamic status in patients operated for IE.


METHODS
A total of 20 patients were randomly assigned to either HA therapy or the control group. HA therapy was initiated intraoperatively and continued for 24 hours, postoperatively. Cytokine levels (IL-6, IL-1b, TNF-α), leucocytes, C-reactive protein (CRP) and Procalcitonin (PCT) as well as catecholamine support and volume requirement were compared between both groups.


RESULTS
Operative procedures included aortic (n=7), mitral (n=6) and multiple valve surgery (n=7). All patients survived to discharge. No significant differences concerning median cytokine levels (IL-6 and TNF-α) were observed between both groups. CRP and PCT baseline levels were significantly higher in the HA group (59.5 vs. 26.3 mg/dl, p=0.029 and 0.17 vs. 0.05 µg/l, p=0.015) equalizing after surgery. Patients in the HA group required significantly higher doses of vasopressors (0.093 vs. 0.025 µg/kg/min norepinephrin, p=0.029) at 12 hours, postoperatively, as well as significantly more overall volume replacement (7217 vs. 4185 ml at 12 hours, p=0.015; 12021 vs. 4850 ml at 48 hours, p=0.015).


CONCLUSIONS
HA therapy did neither result in a reduction of inflammatory parameters nor in an improvement of hemodynamic parameters in patients operated for IE. For a more targeted use of HA therapy, appropriate selection criteria are required.