Systemic Inflammatory Response Syndrome in Heart Surgery: New possibilities for treatment through the use of a cytokine adsorber during ECC?

The ECC is still the key technology in the performance of cardiac surgery. Currently used conventional extracorporeal circulation (CECC) systems need to be further optimized [14]. At LMU Munich positive experiences with minimized perfusion were consistently implemented. Minimized/optimized perfusion can reduce the inflammation by advanced perfusion technology [15, 16, 17, 18], but in complex interventions such as reoperations, hypothermic arrest or multiple interventions you reach the limits. Despite the use of modern perfusion technology, it is possible that a post-perfusion syndrome (PPS) can develop during long operations leading to SIRES in 2-10% of all cases. The newly introduced CytoSorb technology is a promising treatment option in patients with SIRS due to cardiopulmonary bypass surgery and increased cytokine values. Procedures involving the aortic arch, selective antegrade cerebral perfusion and hypothermic arrest require extralong perfusion and ischemic time. It is postulated that the preventative use of a cytokine adsorber during open heart surgery with heart-lung machine has a positive impact on significant clinical and inflammatory parameters. In a retrospective study two patient groups (n=20) were evaluated. The aim of this retrospective observational study is thus to analyze the effect of CytoSorb on the inflammatory response evolving. The IL-6 differs significantly in control and investigatory group during the postoperative course; fibrinogen reacts with significantly lower activation. The leucocyte shows a positive trend in the CytoSorb group. The CRP in the CS group showed a lower rise and a faster normalization. The procalcitonin increased with high significance in the control group.