Extracorporeal Cytokine Hemoadsorption during High-Risk LVAD Implantation: Is It Really Worth?

 

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Objectives: Systemic inflammatory response syndrome (SIRS) after on-pump cardiac surgery is associated with vasoplegic shock leading to multiorgan failure and poor clinical outcome. Extracorporeal cytokine hemoadsorption emerged to reduce postoperative SIRS, potentially improving patient outcome. Nevertheless, its prognostic impact during high-risk LVAD implantation remains unknown.

Methods: A total of 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 with advanced cardiogenic shock (INTERMACS I and II), 9 patients (CytoSorb group) underwent LVAD implantation with, 16 patients (Control group) without simultaneous cytokine hemoadsorption during cardiopulmonary bypass. Besides 30-day mortality rates, hemodynamic, metabolic and clinical variables were retrospectively analyzed.

Result: Apart from an increased rate of re-operations within the CytoSorb-group (55.6 vs. 12.5%; p = 0.02), baseline characteristics including the severity of ventricular dysfunction, as well as consecutive signs of end-organ damage were comparable between both study-groups. Preoperative short term mechanical circulatory support was comparably applied in both study-groups (66.7% in the CytoSorb group vs. 75% in the Control group; p = 0.66). Apart from an increased rate of simultaneous hemofiltration within the CytoSorb group (77.8 vs. 31.3%; p = 0.03), procedural characteristics were comparable in both study-groups. Intraoperative volume management and postoperative vasopressor administration were comparable in both study-groups. Furthermore, 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). In addition, the 30-day mortality rate, predominantly due to multiorgan failure, was significantly increased in the CytoSorb group (33.3 vs. 0.0%; p = 0.01).

Conclusion: 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. Furthermore, there were no beneficial clinical effects in this high-risk patient cohort with preexisting advanced cardiogenic shock.

Publication History

Article published online:
19 February 2021

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