Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
Ann Thorac Surg. 2019 Jul;108(1):45-51. doi: 10.1016/j.athoracsur.2018.12.032. Epub 2019 Jan 23.
The purpose of this study was to analyze the results of Cytosorb (CytoSorbents, Monmouth Junction, NJ) adsorption during emergency open heart operations in patients at high risk of bleeding due to treatment with coagulation-active substances.
We investigated 55 consecutive patients (median age 70 years; interquartile range: 60 to 77) who underwent emergency cardiac surgery at our institution between June 2016 and June 2018. All patients were receiving therapy with either ticagrelor (n = 43) or rivaroxaban (n = 12). In 39 of 55 cases, we routinely installed standardized Cytosorb adsorption into the heart-lung machine. Bleeding complications during and after surgery were analyzed in detail and compared with 16 patients without adsorption.
In the Cytosorb adsorption group, no rethoracotomies had to be performed. Drainage volumes in 24 hours were only 350 mL (interquartile range: 300 to 450 mL) after ticagrelor administration and 390 mL (interquartile range: 310 to 430 mL) after rivaroxaban therapy. In the majority of patients, transfusions of blood products were not needed. Compared with that group, among the group of patients without adsorption, multiple bleeding complications occurred. These were associated with longer total operation (p = 0.0042), higher drainage volumes (p = 0.0037), more transfusions of red blood cells (p = 0.0119) and platelets (p = 0.0475), a significantly higher rethoracotomy rate (p = 0.0003), significantly prolonged stay in the intensive care unit (p = 0.0141), and a longer hospital stay (p = 0.0244).
The intraoperative use of Cytosorb adsorption of ticagrelor and rivaroxaban in emergency open heart operations is reported for the first time. The data show that the strategy is safe and is an effective method to reduce bleeding complications. We recommend the use for safety in patients with ticagrelor or rivaroxaban undergoing emergency cardiac surgery.
本研究的目的是分析在因接受凝血活性物质治疗而有出血高风险的患者中，在急诊心脏手术期间使用 Cytosorb（CytoSorbents，Monmouth Junction，NJ）吸附的结果。
我们调查了 2016 年 6 月至 2018 年 6 月期间在我院接受急诊心脏手术的 55 例连续患者（中位年龄 70 岁；四分位间距：60 至 77）。所有患者均接受替格瑞洛（n=43）或利伐沙班（n=12）治疗。在 55 例病例中的 39 例中，我们常规将标准化 Cytosorb 吸附装置安装到心肺机中。详细分析了手术期间和手术后的出血并发症，并与 16 例未进行吸附的患者进行了比较。
在 Cytosorb 吸附组中，无需再次开胸。替格瑞洛给药后 24 小时的引流量仅为 350ml（四分位间距：300 至 450ml），利伐沙班治疗后为 390ml（四分位间距：310 至 430ml）。在大多数患者中，不需要输注血液制品。与该组相比，未进行吸附的患者组中发生了多种出血并发症。这些并发症与总手术时间延长（p=0.0042）、引流量增加（p=0.0037）、输注红细胞（p=0.0119）和血小板（p=0.0475）有关，再次开胸率显著升高（p=0.0003），重症监护病房停留时间延长（p=0.0141），住院时间延长（p=0.0244）。
首次报道在急诊心脏手术中使用 Cytosorb 吸附替格瑞洛和利伐沙班。数据表明，该策略是安全的，是减少出血并发症的有效方法。我们建议在接受紧急心脏手术的接受替格瑞洛或利伐沙班治疗的患者中使用以确保安全。
