Impact of intraoperative haemoadsorption on outcomes of patients undergoing aortic surgery: a Single-Centre, prospective, observational study.

TITLE: Impact of Intraoperative Haemoadsorption on Outcomes of Patients undergoing Aortic Surgery: A Single-Centre, Prospective, Observational Study.

OBJECTIVES: To investigate the impact of a cytokine haemoadsorption device (CytoSorb®) on inflammatory markers and patients' outcome during aortic root surgery.

METHODS: Prospective, observational study including all-comers with quasi-randomisation by strictly alternating inclusion (1:1 basis). Sixty patients undergoing elective aortic surgery were assigned to either haemoadsorption (HA)-group (n = 30) with intraoperative HA, or a control (C)-group (n = 30). Primary outcomes were: (1) impact of HA on haemodynamic stability and need for vasopressors (vasoactive-inotropic score: VIS) and (2) sequential organ failure assessment (SOFA)-score. Secondary parameters included the impact of HA on the course of hyperinflammation using interleukin (IL)-6 and procalcitonin (PCT), duration of mechanical ventilation, and lengths of intensive care unit (ICU)- and hospital-stay.

RESULTS: Noradrenaline requirement was significantly reduced in the HA-group postoperatively compared to the C-group (HA: 0.03 µg/kg/min vs C: 0.08 µg/kg/min, p = 0.004 at 2 h, and HA: 0.02 µg/kg/min vs C: 0.04 µg/kg/min, p = 0.004 at 24 h). This translated into a significantly lower VIS score in the HA-group. SOFA-score was less in the HA-group at all time points and reached statistical significance 2 h postoperatively (HA: 5.77 vs C: 7.43, p < 0.001). Intraoperative HA significantly reduced IL-6 levels (p < 0.05) at all time points, and PCT at 2 h after discontinuation from cardiopulmonary bypass (p = 0.005). The duration of ventilation, ICU- and hospital-stays were shorter in the HA-group compared to the C-group.

CONCLUSIONS: Intraoperative haemoadsorption has the potential to mitigate hyperinflammatory response leading to improved haemodynamics after aortic root surgery, thereby shortening the duration of ventilation, and lengths of ICU- and hospital-stay. However, it must be evaluated in larger cohorts.