The impact of intraoperative hemoadsorption during cardiac surgery for infective endocarditis

BACKGROUND: Postoperative sepsis and/or systemic inflammatory response syndrome caused by infective endocarditis (IE) can lead to significant postoperative mortality. Intraoperative hemoadsorption therapy has shown promising results in the treatment of sepsis and dysregulated inflammatory response during cardiac surgery. The aim of this study was to evaluate the effects of intraoperative hemoadsorption in high-risk patients with IE undergoing cardiac surgery. METHODS: A total of 176 high-risk patients with IE were enrolled from 10/2020 to 10/2024. Patients with intraoperative hemoadsorption (HA group, n = 93) were compared to patients without hemoadsorption (control, n = 83). The primary endpoint was a composite of 30-day mortality, incidence of vasoplegic syndrome within the first 24 h and 7 days postoperatively, and intensive care (ICU) stay, analyzed using an unmatched hierarchical win-ratio method. RESULTS: There were no differences in baseline characteristics between the groups. The mean hemoadsorption time was 106 ± 61 min in the HA group. Vasoplegic syndrome was more frequent in the control group (49.4% vs. 24.7%, p < 0.001). Importantly, 30-day mortality was also significantly lower with intraoperative hemoadsorption (7.5% vs. 20.5%, p = 0.003). The mean ICU stay was shorter in the HA group (7.8 ± 4.6 vs. 11.5 ± 4.2 days, p < 0.001). The analysis met the primary endpoint in favor of patients receiving intraoperative hemoadsorption (win ratio 3.83; 95% CI 2.55, 5.74; p < 0.001). CONCLUSIONS: In high-risk cardiac surgery patients with IE, the intraoperative use of hemoadsorption was associated with a significantly lower incidence of postoperative vasoplegic syndrome and lower overall 30-day mortality. These findings should be interpreted in the context of the study's methodological limitations and confirmed in future randomized controlled trials. TRIAL REGISTRATION: This study was approved by the Institutional Review Board (IRB00012919) of the French Society of Thoracic and Cardiovascular Surgery (CERCSFCTCV20251021).