CytoSorb in Endocarditis Patients Undergoing Valve Surgery

Objectives: The Cytosorb Adsorber (Cytosorbents Corporation, USA) was designed to eliminate inflammatory mediators during cardiopulmonary bypass to decrease inflammatory response and improve outcome. Existing data describe Cytosorb therapy to be safe. The aim of this study was to evaluate outcome of endocarditis patients undergoing valve surgery with the Cytosorb Adsorber. This is, to our knowledge, the first retrospective propensity-weighted analysis, which evaluates the potential of Cytosorb in endocarditis patients.

Methods: A retrospective single-center database analysis was performed. From 2009 to 2019, a total of 228 patients underwent valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. Two groups (Cytosorb vs. control) were propensity weighted for comparability. Primary endpoint was in-hospital mortality. Secondary endpoints were length of intensive care unit and in-hospital stay.

Results: After successful propensity weighting, a total of 195 patients (Cytosorb: n = 26; control: n = 169) were included in this analysis. In-hospital mortality (Cytosorb vs. control: 15 vs. 9%; p = 0.401), major adverse cardiac and cerebrovascular events (20 vs. 12%; p = 0.302), postoperative renal failure (17 vs. 20%; p = 0.744), and intubation > 72 hours (8 vs. 7%; p = 0.905) were equal in both groups. Reoperation for bleeding was significantly increased in the Cytosorb group (25 vs. 8%; p = 0.016). While length of stay at the intensive care unit was prolonged in Cytosorb patients (5.2 vs. 3.4 days; p = 0.014), length of hospital stay was similar in the two groups (15.4 vs. 11.3 days; p = 0.219).

Conclusion: Cytosorb therapy showed no influence on in-hospital mortality, while risk for reoperation due to bleeding was even increased in the Cytosorb group. In summary, no benefits of Cytosorb therapy could be observed in endocarditis patients undergoing valve surgery. Additional analyses are urgently needed to further evaluate potential risks of the Cytosorb Adsorber.