Jonjev Živojin S, Božić Anđela, Bjeljac Ilija, Hrubik Jan, Kalinić Novica
Clinic of Cardiovascular Surgery, Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia.
Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
Am J Case Rep. 2025 Sep 15;26:e948318. doi: 10.12659/AJCR.948318.
BACKGROUND Infective endocarditis (IE) is a life-threatening condition characterized by endocardial infection, systemic inflammation, and potential multi-organ dysfunction. Despite advances in surgical techniques and antimicrobial therapy, outcomes remain suboptimal in high-risk patients. Hemoadsorption using the CytoSorb® device has emerged as a potential adjunctive therapy to mitigate systemic inflammation during cardiopulmonary bypass (CPB) surgery, but its clinical benefit in IE remains under evaluation. CASE REPORT We describe a series of 4 adult patients with confirmed bacterial IE involving the aortic or tricuspid valve, all requiring urgent cardiac surgery. Each patient exhibited clinical signs of sepsis, persistent fever, elevated inflammatory markers, and vegetation on echocardiography. Intraoperatively, CytoSorb hemoadsorption was integrated into the CPB circuit. In all cases, a significant reduction in inflammatory markers (C-reactive protein, procalcitonin), lactate, and vasopressor requirements was observed within 24 hours postoperatively. Mechanical ventilation duration was below institutional averages. No patients required re-operation, mechanical circulatory support, or postoperative hemoadsorption. All were discharged between postoperative days 7 and 17, and follow-up at 6 months revealed no complications or relapses. CONCLUSIONS This case series suggests that intraoperative hemoadsorption using CytoSorb may be a beneficial adjunct in the surgical management of severe IE, particularly in patients with high inflammatory burden. Improvements in hemodynamic stability, inflammatory response, and postoperative recovery were consistently observed. These findings support the need for randomized controlled trials to evaluate patient selection criteria and confirm therapeutic efficacy.
感染性心内膜炎（IE）是一种危及生命的疾病，其特征为心内膜感染、全身炎症反应以及潜在的多器官功能障碍。尽管手术技术和抗菌治疗取得了进展，但高危患者的治疗效果仍不尽人意。使用CytoSorb®装置进行血液吸附已成为一种潜在的辅助治疗方法，可减轻体外循环（CPB）手术期间的全身炎症反应，但其在IE中的临床益处仍在评估中。病例报告：我们描述了4例确诊为细菌性IE的成年患者，病变累及主动脉瓣或三尖瓣，均需要紧急心脏手术。每位患者均表现出败血症的临床症状、持续发热、炎症标志物升高以及超声心动图显示有赘生物。术中，将CytoSorb血液吸附整合到CPB回路中。在所有病例中，术后24小时内观察到炎症标志物（C反应蛋白、降钙素原）、乳酸水平以及血管升压药需求均显著降低。机械通气时间低于机构平均水平。无患者需要再次手术、机械循环支持或术后血液吸附。所有患者均在术后第7至17天出院，6个月的随访显示无并发症或复发。结论：本病例系列表明，术中使用CytoSorb进行血液吸附可能是严重IE外科治疗中的一种有益辅助手段，特别是对于炎症负担较高的患者。持续观察到血流动力学稳定性、炎症反应及术后恢复均有所改善。这些发现支持开展随机对照试验以评估患者选择标准并确认治疗效果。
