Frering Anouk, Abi Lutfallah Antoine, Carillion Aude, Wendt Daniel, Leprince Pascal, Bougle Adrien, Lebreton Guillaume
Sorbonne University, Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
CytoSorbents Europe GmbH, Berlin, Germany.
JHLT Open. 2024 Oct 11;7:100165. doi: 10.1016/j.jhlto.2024.100165. eCollection 2025 Feb.
Heart transplantation is an emergency surgery requiring cardio-pulmonary bypass (CPB) and its timing is unpredictable. Patients on the transplant waiting list often have multiple reasons for being anticoagulated. Intraoperative removal of apixaban using CytoSorb seems to be an interesting solution for patients on DOACs requiring an emergency CPB intervention. The aim of this short communication is to describe the perioperative effects of the use of the CytoSorb hemoadsorption device during emergency CPB for a heart transplant patient.
A 61-year-old male patient wait-listed for heart transplantation was admitted to our hospital to benefit from a heart transplantation. This patient, has an end-stage heart failure with multiple episodes of decompensation over the previous year. He was anticoagulated with a Vitamin K antagonist (VKA) due to atrial fibrillation and was switched to apixaban. Hemoadsorption by a CytoSorb cartridge was performed during the entire CPB duration. Anti-Factor Xa Activity (AFXaA) levels were taken before, during and after surgery in order to monitor anticoagulation.
Surgery consisted of an orthotopic heart transplantation with bi-caval anastomoses. At the time of anesthesia induction and after UFH administration, AFXaA levels were 330ng/mL and 317ng/mL, respectively. Thereafter, AFXaA decreased to 137ng/mL during CPB and to 57ng/mL after the end of CPB and protamine administration. After surgery, AFXaA levels stabilized over 50ng/mL over the next 14 hours. No primary graft dysfunction was observed, and during the post-operative period of 72 hours, the patient did not have any bleeding events requiring reintervention or transfusion.
We observed that CytoSorb could be a potential solution to remove apixaban intraoperatively. If this efficacy is confirmed in larger trials, it would allow transplant candidates to be treated with DOACs without requiring a switch to VKAs.
心脏移植是一种需要体外循环（CPB）的急诊手术，其时机难以预测。移植等待名单上的患者常有多种抗凝原因。对于需要紧急CPB干预的直接口服抗凝剂（DOAC）使用者，术中使用CytoSorb去除阿哌沙班似乎是一个有趣的解决方案。本简短通讯的目的是描述在心脏移植患者的紧急CPB期间使用CytoSorb血液吸附装置的围手术期效果。
一名61岁等待心脏移植的男性患者入住我院接受心脏移植。该患者患有终末期心力衰竭，前一年有多次失代偿发作。由于房颤，他接受了维生素K拮抗剂（VKA）抗凝治疗，后改用阿哌沙班。在整个CPB期间，使用CytoSorb柱进行血液吸附。在手术前、手术中和手术后检测抗Xa因子活性（AFXaA）水平，以监测抗凝情况。
手术为原位心脏移植，采用双腔静脉吻合。麻醉诱导时和给予普通肝素（UFH）后，AFXaA水平分别为330ng/mL和317ng/mL。此后，CPB期间AFXaA降至137ng/mL，CPB结束和给予鱼精蛋白后降至57ng/mL。术后，AFXaA水平在接下来的14小时内稳定在50ng/mL以上。未观察到原发性移植物功能障碍，在术后72小时内，患者没有发生需要再次干预或输血的出血事件。
我们观察到CytoSorb可能是术中去除阿哌沙班的潜在解决方案。如果在更大规模的试验中证实这种疗效，将允许移植候选者使用DOACs治疗，而无需改用VKA。
