Manohar Murali, Jawali Vivek, Neginahal Siddu, Gt Sudarshan, Muniraj Geetha, Chakravarthy Murali
Cardiac Surgery Department, Fortis Hospital, Bengaluru 560076, India.
Cardiac Sciences Board, Fortis Hospital, Bengaluru 560076, India.
J Clin Med. 2022 Nov 27;11(23):7005. doi: 10.3390/jcm11237005.
(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group ( = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb hemoadsorption in complex cardiac surgery and a trend of lower mortality.
(1) 背景:心脏手术可能引发全身性炎症反应,在复杂、联合、再次手术及急诊手术且主动脉阻断时间较长的情况下,这种反应通常会加剧。已引入多种治疗方案来帮助控制心脏手术后的过度炎症,包括使用CytoSorb进行血液吸附免疫调节。(2) 方法:我们对接受复杂心脏手术的患者进行了一项单中心回顾性观察研究。将术中接受CytoSorb治疗的患者与对照组进行比较。主要结局是血管活性药物评分(VIS)从术前到术后的变化。(3) 结果:共有52例患者纳入分析,其中23例接受CytoSorb(CS)治疗,29例未接受治疗(对照组)。与对照组相比,CS组术前至术后VIS的平均增加值显著更低(分别为3.5和5.5,P = 0.05)。对照组的院内死亡率为20.7%(6例患者),CS组为9.1%(2例患者)(P = 0.26)。乳酸水平变化相当,两组间重症监护病房和住院时间中位数相似。(4) 结论:尽管两组之间存在明显失衡,但研究结果表明,在复杂心脏手术中,CytoSorb血液吸附可带来更好的血流动力学稳定性,并呈现出死亡率降低的趋势。