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
