IS THERE A ROLE FOR HEMOADSORPTION DURING CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST IN ACUTE AORTIC DISSECTION SURGERY?

Background: This retrospective single-center study evaluates the effects of hemadsorption with CytoSorb ® on the vasoactive and inotropic support in patients undergoing surgery for acute aortic dissection (AAD) with circulatory arrest. Methods: We enrolled 29 consecutive patients undergoing AAD surgery with Cytosorb®, between May 2022 and June 2024, and 33 consecutive patients previously treated without Cytosorb® (January 2018 – May 2022). The primary endpoint was the changes in vasoactive- inotropic score (VIS), which quantifies the degree of hemodynamic support. VIS and drugs’ doses were collected at 8 time-points from preoperative to 72 hours after surgery. Nonparametric tests were applied and p<0.05 was settled for statistical significance. Results: Baseline characteristics did not differ between the two groups, except for the cardiopulmonary bypass temperature and circulatory arrest time, which are not significant related to drug request at linear regression. The median VIS showed a trend with two peaks, one early after cardiopulmonary bypass discontinuation and one 6 hours after surgery. The drugs’ doses and VIS were lower in Cytosorb® group at any time-points, with significant lower value of VIS from the ICU admission (p=0.026) to 24 hours after surgery (p=0.029). Nevertheless, there were no differences in clinical outcome (in-hospital mortality, p=1; hospital lengths of stay, p=0.1; postoperative highest creatinine value, p=0.05). Conclusions: Evidence on CytoSorb® during AAD surgery is poor. In this scenario, our results suggest an improved hemodynamic stability using CytoSorb®. However, many factors may compete to vasoactive request and further examination in large sample sizes are needed.