Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Centre, University Hospital Essen, Essen, Germany.
Ann Thorac Surg. 2020 Sep;110(3):890-896. doi: 10.1016/j.athoracsur.2019.12.067. Epub 2020 Feb 12.
Cardiac surgery in patients with infective endocarditis is associated with high mortality owing 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.
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 end points 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.
A total of 58 consecutive patients were included: 30 in the hemoadsorption group and 28 in the control group. Postoperative sepsis occurred in 5 patients in the hemoadsorption group and in 11 in the control group (P = .05). No sepsis-associated death occurred in the hemoadsorption group, whereas five septic patients in the control group died (P = .02). Thirty-day mortality was 10% in the hemoadsorption group versus 18% in the control group (P = .39). On intensive care unit admission, the cumulative need for epinephrine and norepinephrine was 0.15 versus 0.24 μg/kg body weight/min (P = .01) and the median systemic vascular resistance was 1413 versus 1010 dyn·s·cm (P = .02) in the hemoadsorption versus control group, respectively.
Intraoperative hemoadsorption might reduce the incidence of postoperative sepsis and sepsis-related death. In addition, patients with intraoperative hemoadsorption showed greater hemodynamic stability. These data suggest that intraoperative hemoadsorption may improve surgical outcome in patients with mitral valve endocarditis.
由于术后感染性多器官衰竭，心脏手术合并感染性心内膜炎患者的死亡率较高。血液吸附疗法可通过减少循环细胞因子来改善手术结果。我们旨在评估术中血液吸附在二尖瓣心内膜炎患者中的临床效果。
合格的候选者是在 2014 年 1 月至 2018 年 7 月期间接受心脏手术的原发性二尖瓣感染性心内膜炎患者。将接受术中血液吸附（血液吸附组）的患者与未接受血液吸附的手术患者（对照组）进行比较。终点是术后败血症的发生率、败血症相关死亡和 30 天死亡率。此外，还评估了术后肾上腺素和去甲肾上腺素以及全身血管阻力的需要。
共纳入 58 例连续患者：血液吸附组 30 例，对照组 28 例。血液吸附组术后发生败血症 5 例，对照组 11 例（P=0.05）。血液吸附组无败血症相关死亡，而对照组 5 例败血症患者死亡（P=0.02）。血液吸附组 30 天死亡率为 10%，对照组为 18%（P=0.39）。在重症监护病房入院时，血液吸附组肾上腺素和去甲肾上腺素的累积需要量为 0.15μg/kg 体重/分钟，而对照组为 0.24μg/kg 体重/分钟（P=0.01），血液吸附组的中位全身血管阻力为 1413dyn·s·cm，而对照组为 1010dyn·s·cm（P=0.02）。
术中血液吸附可能降低术后败血症和败血症相关死亡的发生率。此外，接受术中血液吸附的患者表现出更大的血流动力学稳定性。这些数据表明，术中血液吸附可能改善二尖瓣心内膜炎患者的手术结果。
