Preliminary Experience of Extracorporeal Cytokine Hemoadsorption during Left Ventricular Assist Device Implantation in Cardiogenic Shock Patients

Abstract

Background Systemic inflammation due to cardiogenic shock is associated with vasoplegia leading to organ hypoperfusion, right heart failure, and poor clinical outcome. Extracorporeal cytokine hemoadsorption emerged to attenuate excessive levels of inflammatory cytokines, potentially improving patient outcomes. Nevertheless, its prognostic impact during high-risk left ventricular assist device (LVAD) implantation remains unknown.

Methods In total, 40 consecutive patients with advanced heart failure underwent continuous-flow LVAD implantation at our institution between 2018 and 2020. Out of 25 high-risk patients in cardiogenic shock (Interagency Registry for Mechanically Assisted Circulatory Support profile 1 and 2), 9 patients (CytoSorb group) underwent LVAD implantation with and 16 patients (control group) without simultaneous cytokine hemoadsorption during cardiopulmonary bypass. Besides preoperative patient characteristics, postoperative lactate clearance, vasopressor administration and mean arterial pressure, perioperative complication, and 30-day mortality rates were retrospectively analyzed.

Results Apart from an increased rate of reoperations within the CytoSorb group, baseline characteristics including the severity of ventricular dysfunction and consecutive signs of end-organ failure were similar in both groups. Preoperative short-term mechanical circulatory support bridging was comparable (66.7 vs. 75%; p = 0.66) prior to LVAD implantation. Procedural characteristics including intraoperative volume management and postoperative vasopressor administration were similar in both groups. There was no difference regarding postoperative lactate clearance, although postoperative mean arterial pressure was significantly higher in the control group (71.3 vs. 57.4 mm Hg; p < 0.01). Furthermore, the 30-day mortality rate was significantly higher in the CytoSorb group (33.3 vs. 0.0%; p = 0.01).

Conclusion Extracorporeal cytokine hemoadsorption during high-risk LVAD implantation was not associated with a decrease of postoperative vasopressor support, improved hemodynamics, or an accelerated lactate clearance.

Keywords

left ventricular assist device - cytokine hemoadsorption - cardiogenic shock - vasoplegia

Note

Data were presented at the virtual DGTHG 50th Annual Meeting 2021. The manuscript or part of it has neither been published (except in the form of an abstract at the DGTHG 50th Annual Meeting 2021) nor is currently under consideration for publication by any other journal.

Authors' Contribution

J.P. and A.B. analyzed and interpreted the patient data and wrote the manuscript. J.P., J.M., and O.B., were involved in data collection and literature review. M.B., Y.A., L. S.-U. and H.R. were involved in reviewing the manuscript. All authors read and approved the manuscript.

Publikationsverlauf

Eingereicht: 14. Mai 2022

Angenommen: 08. August 2022

Artikel online veröffentlicht:
10. Oktober 2022

• References

• 1 McDonagh TA, Metra M, Adamo M. et al; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42 (36) 3599-3726
• 2 Kittleson MM, Shah P, Lala A. et al; REVIVAL Investigators. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: a report from the REVIVAL Registry. J Heart Lung Transplant 2020; 39 (01) 16-26
• 3 Zhigalov K, Van den Eynde J, Chrosch T. et al. Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): a retrospective study. Artif Organs 2021; 45 (07) 706-716
• 4 Molina EJ, Shah P, Kiernan MS. et al. The Society of Thoracic Surgeons Intermacs 2020 Annual Report. Ann Thorac Surg 2021; 111 (03) 778-792
• 5 Murphy SP, Kakkar R, McCarthy CP, Januzzi Jr JL. Inflammation in heart failure: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75 (11) 1324-1340
• 6 Caruso R, Botta L, Verde A. et al. Relationship between pre-implant interleukin-6 levels, inflammatory response, and early outcome in patients supported by left ventricular assist device: a prospective study. PLoS One 2014; 9 (03) e90802
• 7 Caruso R, Verde A, Cabiati M. et al. Association of pre-operative interleukin-6 levels with Interagency Registry for Mechanically Assisted Circulatory Support profiles and intensive care unit stay in left ventricular assist device patients. J Heart Lung Transplant 2012; 31 (06) 625-633
• 8 Omar S, Zedan A, Nugent K. Cardiac vasoplegia syndrome: pathophysiology, risk factors and treatment. Am J Med Sci 2015; 349 (01) 80-88
• 9 Datt V, Wadhhwa R, Sharma V, Virmani S, Minhas HS, Malik S. Vasoplegic syndrome after cardiovascular surgery: a review of pathophysiology and outcome-oriented therapeutic management. J Card Surg 2021; 36 (10) 3749-3760
• 10 Squiccimarro E, Labriola C, Malvindi PG. et al. Prevalence and clinical impact of systemic inflammatory reaction after cardiac surgery. J Cardiothorac Vasc Anesth 2019; 33 (06) 1682-1690
• 11 Poli EC, Rimmelé T, Schneider AG. Hemoadsorption with CytoSorb^® . Intensive Care Med 2019; 45 (02) 236-239
• 12 Poli EC, Alberio L, Bauer-Doerries A. et al. Cytokine clearance with CytoSorb® during cardiac surgery: a pilot randomized controlled trial. Crit Care 2019; 23 (01) 108
• 13 Träger K, Skrabal C, Fischer G. et al. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass—a case series. Int J Artif Organs 2017; 40 (05) 240-249
• 14 Stevenson LW, Pagani FD, Young JB. et al. INTERMACS profiles of advanced heart failure: the current picture. J Heart Lung Transplant 2009; 28 (06) 535-541
• 15 Zhang Y, Bauersachs J, Langer HF. Immune mechanisms in heart failure. Eur J Heart Fail 2017; 19 (11) 1379-1389
• 16 Tecson KM, Lima B, Lee AY. et al. Determinants and outcomes of vasoplegia following left ventricular assist device implantation. J Am Heart Assoc 2018; 7 (11) e008377
• 17 vanVessem ME, Palmen M, Couperus LE. et al. Incidence and predictors of vasoplegia after heart failure surgery. Eur J Cardiothorac Surg 2017; 51 (03) 532-538
• 18 Kirklin JK, Pagani FD, Kormos RL. et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant 2017; 36 (10) 1080-1086
• 19 Napp LC, Ziegeler S, Kindgen-Milles D. Rationale of hemoadsorption during extracorporeal membrane oxygenation support. Blood Purif 2019; 48 (03) 203-214
• 20 de Waal EEC, van Zaane B, van der Schoot MM. et al. Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence, outcomes and predictors. BMC Anesthesiol 2018; 18 (01) 185
• 21 Träger K, Fritzler D, Fischer G. et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs 2016; 39 (03) 141-146
• 22 Stupica GT, Sostaric M, Bozhinovska M. et al. Extracorporeal hemadsorption versus glucocorticoids during cardiopulmonary bypass: a prospective, randomized, controlled trial. Cardiovasc Ther 2020; 2020: 7834173
• 23 Bernardi MH, Rinoesl H, Dragosits K. et al. Effect of hemoadsorption during cardiopulmonary bypass surgery—a blinded, randomized, controlled pilot study using a novel adsorbent. Crit Care 2016; 20: 96
• 24 Haidari Z, Wendt D, Thielmann M. et al. Intraoperative hemoadsorption in patients with native mitral valve infective endocarditis. Ann Thorac Surg 2020; 110 (03) 890-896
• 25 Diab M, Tasar R, Sponholz C. et al. Changes in inflammatory and vasoactive mediator profiles during valvular surgery with or without infective endocarditis: a case control pilot study. PLoS One 2020; 15 (02) e0228286
• 26 Diab M, Lehmann T, Bothe W. et al; REMOVE Trial Investigators.. Cytokine hemoadsorption during cardiac surgery versus standard surgical care for infective endocarditis (REMOVE): results from a multicenter randomized controlled trial. Circulation 2022; 145 (13) 959-968
• 27 Supady A, Weber E, Rieder M. et al. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): a single centre, open-label, randomised, controlled trial. Lancet Respir Med 2021; 9 (07) 755-762
• 28 Garcia PDW, Hilty MP, Held U, Kleinert EM, Maggiorini M. Cytokine adsorption in severe, refractory septic shock. Intensive Care Med 2021; 47 (11) 1334-1336
• 29 Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation 2001; 103 (16) 2055-2059
• 30 Supady A, Zahn T, Rieder M. et al. Effect of cytokine adsorption on survival and circulatory stabilization in patients receiving extracorporeal cardiopulmonary resuscitation. ASAIO J 2022; 68 (01) 64-72
• 31 Grosman-Rimon L, Jacobs I, Tumiati LC. et al. Longitudinal assessment of inflammation in recipients of continuous-flow left ventricular assist devices. Can J Cardiol 2015; 31 (03) 348-356