Extracorporeal Blood Purification with CytoSorb® Hemoadsorption in Valve Surgery for Infective Endocarditis: A Case Series

BACKGROUND Infective endocarditis (IE) is a life-threatening condition characterized by endocardial infection, systemic inflammation, and potential multi-organ dysfunction. Despite advances in surgical techniques and antimicrobial therapy, outcomes remain suboptimal in high-risk patients. Hemoadsorption using the CytoSorb® device has emerged as a potential adjunctive therapy to mitigate systemic inflammation during cardiopulmonary bypass (CPB) surgery, but its clinical benefit in IE remains under evaluation. CASE REPORT We describe a series of 4 adult patients with confirmed bacterial IE involving the aortic or tricuspid valve, all requiring urgent cardiac surgery. Each patient exhibited clinical signs of sepsis, persistent fever, elevated inflammatory markers, and vegetation on echocardiography. Intraoperatively, CytoSorb hemoadsorption was integrated into the CPB circuit. In all cases, a significant reduction in inflammatory markers (C-reactive protein, procalcitonin), lactate, and vasopressor requirements was observed within 24 hours postoperatively. Mechanical ventilation duration was below institutional averages. No patients required re-operation, mechanical circulatory support, or postoperative hemoadsorption. All were discharged between postoperative days 7 and 17, and follow-up at 6 months revealed no complications or relapses. CONCLUSIONS This case series suggests that intraoperative hemoadsorption using CytoSorb may be a beneficial adjunct in the surgical management of severe IE, particularly in patients with high inflammatory burden. Improvements in hemodynamic stability, inflammatory response, and postoperative recovery were consistently observed. These findings support the need for randomized controlled trials to evaluate patient selection criteria and confirm therapeutic efficacy.