Медицина неотложных состояний (Mar 2024)
Comprehensive approach to the treatment of infectious endocarditis, complicated by acute heart failure, with the use of intraoperative hemoadsorption
Abstract
Background. Hemoadsorption plays a pivotal role in the treatment of infectious endocarditis. The incidence of infectious endocarditis is reported at 3–7 cases per 100,000 individuals annually, with an in-hospital mortality rate ranging from 14 to 22 %. This is mainly attributed to acute heart failure, observed in 19 to 73 % of patients with infectious endocarditis, necessitating urgent surgical intervention. Hemoadsorption presents a promising strategy with a potential to improve overall treatment and outcomes in infectious endocarditis complicated by acute heart failure. The purpose was to assess the efficacy of intraoperative hemoadsorption in patients with infectious endocarditis complicated by acute heart failure. Materials and methods. The research included clinical data from 100 patients who underwent surgery for active infectious endocarditis using cardiopulmonary bypass between January 1, 2020, and December 31, 2020. In 25 cases from the general cohort, intraope-rative hemoadsorption was performed with the use of hemoperfusion cartridges. Analysis of clinical characteristics and biochemical data was conducted in patients with infectious endocarditis based on the intraoperative application of hemoadsorption. Results. Significant differences were observed between groups in the duration of inotropic and vasopressor support. The duration of dobutamine infusion in the group without hemoadsorption was significantly longer — 59.4 ± 6.2 hours compared to 38.2 ± 2.7 hours in patients with infectious endocarditis who were operated using intraoperative hemoadsorption (p = 0.047). Norepinephrine in the perioperative period was also used longer in the group without hemoadsorption — 39.4 ± 8.2 hours (p = 0.053). The duration of mechanical ventilation in patients with infectious endocarditis was reduced — 16.1 ± 0.9 hours compared to 19.3 ± 1.2 hours in the group without hemoadsorption (p = 0.091). With the application of hemoadsorption, there was a radical decrease in the levels of C-reactive protein and procalcitonin at all stages of the study. Conclusions. Our study suggests that hemoadsorption can be an effective strategy in the treatment of infectious endocarditis, improving the course of the early postoperative period and the dynamics of inflammatory markers.
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