The role of hemoadsorption in cardiac surgery – a systematic review

Abstract

Abstract Background Despite advancements, cardiopulmonary bypass-assisted cardiac surgery still carries a significant risk for morbidity and mortality, often related to postoperative hyperinflammation. Hemoadsorption of cytokines and various exogenous and endogenous inflammation triggers has been increasingly used in cardiac surgery to mitigate the risk of inflammation-mediated complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to assess the role of perioperative hemoadsorption in cardiac surgery critically. Methods A comprehensive literature search with predefined criteria was conducted. The screening and selection process followed rigorous scientific principles (PRISMA statement). The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search and retrieve all available data. Results The search resulted in 29 publications that were grouped and descriptively analyzed due to the remarkable variability in study designs, however, they all reported exclusively on CytoSorbâ therapy. CytoSorbâ use was proven feasible and safe with no unanticipated device-related adverse events reported in the retrieved articles. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability. Conclusions The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery of patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Current evidence suggests limited value from CytoSorb® use in routine elective surgery and low-risk patients. Further evaluation in more extensive prospective trials is required concerning proper patient selection and postoperative timing and administration.