P108: Analysis Of Postoperative Cytokine Adsorber Therapy (Cytosorbentstm Inc Cytosorb®) In Patients With Condition After Implantation Of A Mechanical Left Ventricular Assist Device (Medtronic Heartwaretm HVADTM System)

Abstract

Background: The CytoSorb® is used to adsorb low and medium molecular weight hydrophobic substances to counteract increasing organ dysfunction by reducing inflammatory mediators, metabolites and proteins, thus potentially positively influencing the recovery process. The aim of this study is to evaluate the effects of the CytoSorb® on the selected organ functions heart, kidneys and liver in patients undergoing implantation of a Medtronic HeartwareTM-HVADTM-LVAD. Methods: A monocentric retrospective observational study was performed. After evaluation of the in-clinic database, 19 patients underwent LVAD implantation at the Department of Cardiac Surgery, Erlangen University Hospital, from Nov 1, 2019 to Jan 1, 2021. Of these, 6 patients received postoperative therapy with CytoSorb® (CytoSorbentsTM Inc) and formed group “A” of this study. A control group “non-A” without CytoSorb® was matched to group “A” regarding: age, sex, BMI, EuroSCORE II, duration of surgery, defined pre- and postoperative laboratory parameters and outcome. The use of cytokine adsorber in group “A” was analyzed. Its effects on heart, kidneys and liver were assessed by defined laboratory parameters (myoglobin, CK, creatinine, urea, BUN, total bilirubin and AST) and at defined time points. The outcome of patients in group “A” was assessed by 30-day mortality. Results: The group comparison showed: group “A” had a higher arithmetic mean risk profile in the EuroSCORE II (m(A) 10.3% vs. m(non-A) 7.2%), a higher BMI (m(A) 32.26 kg/m2 vs. m(non-A) 26.75 kg/m2), and a longer duration of surgery (m(A) 176 min. vs. m(non-A) 145 min.). Preoperative laboratory parameters: higher values in group “A” for creatinine, urea, BUN, total bilirubin, and AST; lower values in group “A” for myoglobin and CK. 24 hours postoperatively: a statistically significant difference for total bilirubin (95% CI: 0.48 to 7.42; p = 0.03), at a fixed significance level of α < 0.05, no significant differences for myoglobin, CK, creatinine, urea and AST for both groups. Analysis of group “A” in the first 24 h after starting therapy: the serum levels of myoglobin, creatinine, urea, total bilirubin and AST did not increase further on arithmetic average or began to decrease moderately. For CK, this effect was seen with a 24 h time lag. A statistically significant decrease for urea was observed over the entire 72 h period (95% CI: - 35.097 to - 7.073; p = 0.006), and the use of the adsorber correlated with a decrease in the value by an average of 21.08 points. Outcome group “A” : 3 patients in group “A” with late mortality > 30 days. Conclusion: The CytoSorb® therapy in group “A” did not lead to any further increase in the arithmetic mean values of the laboratory values examined over the entire time course of the analysis. A rebound in serum levels was observed for myoglobin and total bilirubin after termination of adsorber therapy. Persistent or further increasing organ dysfunction of heart and liver could be considered as causal.