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Preliminary Experience of Extracorporeal Cytokine Hemoadsorption during Left Ventricular Assist Device Implantation in Cardiogenic Shock Patients.
- Source :
-
The Thoracic and cardiovascular surgeon [Thorac Cardiovasc Surg] 2024 Jun; Vol. 72 (4), pp. 266-272. Date of Electronic Publication: 2022 Oct 10. - Publication Year :
- 2024
-
Abstract
- Background: 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 outcomes. Nevertheless, its prognostic impact during high-risk left ventricular assist device (LVAD) implantation remains unknown.<br />Methods: In total, 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 (Interagency Registry for Mechanically Assisted Circulatory Support profile 1 and 2), 9 patients ( CytoSorb group ) underwent LVAD implantation with and 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.<br />Results: Apart from an increased rate of reoperations within the CytoSorb group, baseline characteristics including the severity of ventricular dysfunction and consecutive signs of end-organ failure were similar in both groups. 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 (71.3 vs. 57.4 mm Hg; p < 0.01). Furthermore, the 30-day mortality rate was significantly higher in the CytoSorb group (33.3 vs. 0.0%; p = 0.01).<br />Conclusion: Extracorporeal cytokine hemoadsorption during high-risk LVAD implantation was not associated with a decrease of postoperative vasopressor support, improved hemodynamics, or an accelerated lactate clearance.<br />Competing Interests: A.M.B declared personal fees from Abbott, Abiomed, AstraZeneca, BerlinHeart, and Medtronic. H.R. declared travel grants from Abbott and Medtronic. Additionally, here are no further disclosures.<br /> (Thieme. All rights reserved.)
- Subjects :
- Humans
Male
Female
Middle Aged
Retrospective Studies
Treatment Outcome
Aged
Time Factors
Risk Factors
Heart Failure mortality
Heart Failure physiopathology
Heart Failure diagnosis
Heart Failure therapy
Heart Failure blood
Inflammation Mediators blood
Prosthesis Implantation adverse effects
Prosthesis Implantation mortality
Prosthesis Implantation instrumentation
Risk Assessment
Biomarkers blood
Cardiopulmonary Bypass adverse effects
Cardiopulmonary Bypass mortality
Heart-Assist Devices
Shock, Cardiogenic mortality
Shock, Cardiogenic diagnosis
Shock, Cardiogenic therapy
Shock, Cardiogenic physiopathology
Shock, Cardiogenic blood
Shock, Cardiogenic etiology
Ventricular Function, Left
Recovery of Function
Cytokines blood
Subjects
Details
- Language :
- English
- ISSN :
- 1439-1902
- Volume :
- 72
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Thoracic and cardiovascular surgeon
- Publication Type :
- Academic Journal
- Accession number :
- 36216331
- Full Text :
- https://doi.org/10.1055/s-0042-1757300