Spatola Leonardo, Granata Antonio, D'Amico Maria, Oddo Gaspare, Gambaro Alessia
Division of Nephrology and Dialysis, Ospedale Sant' Antonio Abate, AspTrapani, Via Cosenza, Erice, (TP), Italy.
Division Of Nephrology and Dialysis, Ospedale Cannizzaro, Via Messina, Catania, (CT), Italy.
J Artif Organs. 2024 Dec 21. doi: 10.1007/s10047-024-01485-5.
Cardiac surgery patients are potentially exposed to an acute inflammatory host response with a huge release of both pro- and anti-inflammatory cytokines both through intrinsic (e.g., tissue damage, endothelial injury) and extrinsic (e.g., anesthesia, extracorporeal circuits) mechanisms. Current standard of care therapy includes several invasive supportive treatments such as mechanical ventilation, continuous renal replacement therapy, ECMO, and/or cardiopulmonary bypass which may be responsible for an important inflammatory response. The inflammatory cytokine levels and hemodynamic status following these artificial treatments along with the current standard therapy are not always well controlled and may lead to worsened acute clinical conditions with prolonged in-hospital length of stay and increased mortality. In these settings, the administration of hemadsorption therapy with CytoSorb® has been supported by the successful results in several clinical studies as it has shown improvement of both the inflammatory profile and the hemodynamic vascular status of the patients. Therefore, in this narrative review, we summarized and discussed the current scientific literature on the role of CytoSorb treatment in case of cardiac surgery. According to the current evidences, the raised inflammatory levels and both inotropic and vasopressor requests in cardiac surgery patients need more tailored therapies and, in this contest, the hemadsorption with CytoSorb could play a pivotal role, especially on heart transplant patients. Furthermore, CytoSorb is currently the only hemadsorption sorbent authorized and efficiently applied for removing anticoagulant agents such as ticagrelor or rivaroxaban in patients undergoing cardiac surgery, to reduce perioperative bleeding complications and should be considered in high-risk patients.
心脏手术患者可能会因内在（如组织损伤、内皮损伤）和外在（如麻醉、体外循环）机制而暴露于急性炎症宿主反应中，导致促炎和抗炎细胞因子大量释放。当前的标准治疗方法包括多种侵入性支持治疗，如机械通气、持续肾脏替代治疗、体外膜肺氧合（ECMO）和/或心肺旁路，这些治疗可能会引发重要的炎症反应。这些人工治疗以及当前标准治疗后的炎症细胞因子水平和血流动力学状态并不总是能得到很好的控制，可能会导致急性临床状况恶化，住院时间延长和死亡率增加。在这些情况下，使用CytoSorb®进行血液吸附治疗已在多项临床研究中取得成功结果，因为它显示出患者的炎症指标和血流动力学血管状态均有所改善。因此，在本叙述性综述中，我们总结并讨论了关于CytoSorb治疗在心脏手术中的作用的当前科学文献。根据目前的证据，心脏手术患者炎症水平升高以及对正性肌力药和血管升压药的需求需要更有针对性的治疗，在这种情况下，使用CytoSorb进行血液吸附可能发挥关键作用，尤其是对心脏移植患者。此外，CytoSorb是目前唯一被授权并有效应用于去除心脏手术患者体内抗凝剂（如替格瑞洛或利伐沙班）的血液吸附吸附剂，以减少围手术期出血并发症，高危患者应考虑使用。
