Intraoperative hemoadsorption in patients with native mitral valve infective endocarditis

Abstract Background Cardiac surgery in patients with infective endocarditis is associated with high mortality due to postoperative septic multiorgan failure. Hemoadsorption therapy may improve surgical outcomes by reducing the circulating cytokines. We aimed to evaluate the clinical effects of intraoperative hemoadsorption in patients with mitral valve endocarditis. Methods Eligible candidates were patients with infective endocarditis of the native mitral valve undergoing cardiac surgery between January 2014 and July 2018. Patients with intraoperative hemoadsorption (hemoadsorption) were compared with surgery without hemoadsorption (control). The endpoints were the incidence of postoperative sepsis, sepsis-associated death and 30-day mortality. Furthermore, postoperative need for epinephrine and norepinephrine and systemic vascular resistance were evaluated. Results 58 consecutive patients were included, 30 patients in the hemoadsorption group and 28 patients in the control group. Postoperative sepsis occurred in five patients in the hemoadsorption group and in 11 patients in the control group (p=0.05). No sepsis-associated death occurred in the hemoadsorption group, while five septic patients in the control group died (p=0.02). 30-day-mortality was 10% in the hemoadsorption group versus 18% in the control group, p=0.39. On ICU-admission, the cumulative need for epinephrine and norepinephrine was 0.15 versus 0.24 μg/kgBW/min, p=0.01 and the median systemic vascular resistance was 1413 versus 1010 dyn·s·cm-5, p=0.02 in the hemoadsorption versus control group, respectively. Conclusions Intraoperative hemoadsorption might reduce the incidence of postoperative sepsis and sepsis-related death. Additionally, patients with intraoperative hemoadsorption showed greater hemodynamic stability. These data suggest that intraoperative hemoadsorption may improve surgical outcome in patients with mitral valve endocarditis.