Preliminary Experience of Extracorporeal Cytokine Hemoadsorption During Lvad Implantation in Cardiogenic Shock Patients.

Systemic inflammation due to cardiogenic shock is associated with vasoplegia leading to organ-hypoperfusion, right heart failure and poor clinical outcome. Extracorporeal cytokine hemoadsorption emerged to attenuate excessive levels of inflammatory cytokines, potentially improving patient outcome. Nevertheless, its prognostic impact during high-risk LVAD implantation remains unknown. 40 consecutive patients with advanced heart failure underwent continuous-flow LVAD implantation at our institution between 2018 and 2020. Out of 25 high-risk patients in cardiogenic shock (INTERMACS profile 1 and 2), 9 patients (CytoSorb-group) underwent LVAD implantation with, 16 patients (Control-group) without simultaneous cytokine hemoadsorption during cardiopulmonary bypass. Besides preoperative patient characteristics, postoperative lactate clearance, vasopressor administration and mean arterial pressure, perioperative complication and 30-day mortality rates, were retrospectively analyzed. Apart from an increased rate of re-operations within the CytoSorb-group baseline characteristics including the severity of left and right ventricular dysfunction and consecutive signs of end-organ failure were similar in both groups. Of note, all included patients, were categorized as INTERMACS profile ≤2 prior to LVAD implantation. Preoperative short-term mechanical circulatory support bridging was comparable (66.7% vs. 75%; p=0.66) prior to LVAD implantation. Procedural characteristics including intraoperative volume management and postoperative vasopressor administration were similar in both groups. There was no difference regarding postoperative lactate clearance, although postoperative mean arterial pressure was significantly higher in the Control-group (71.3mmHg vs. 57.4mmHg; p<0.01). Furthermore, the 30-day mortality rate was significantly higher in the CytoSorb-group (33.3 vs. 0.0%; p=0.01). Extracorporeal cytokine hemoadsorption during high-risk LVAD implantation was not associated with a decrease of postoperative vasopressor support, improved hemodynamics, nor an accelerated lactate clearance. [ABSTRACT FROM AUTHOR]