The role of hemoadsorption in cardiac surgery - a systematic review

BACKGROUND: Extracorporeal blood purification has been widely used in intensive care medicine, nephrology, toxicology, and other fields. During the last decade, with the emergence of new adsorptive blood purification devices, hemoadsorption has been increasingly applied during CPB in cardiac surgery, for patients at different inflammatory risks, or for postoperative complications. Clinical evidence so far has not provided definite answers concerning this adjunctive treatment. The current systematic review aimed to critically assess the role of perioperative hemoadsorption in cardiac surgery, by summarizing the current knowledge in this clinical setting. METHODS: A literature search of PubMed, Cochrane library, and the database provided by CytoSorbents was conducted on June 1st, 2023. The search terms were chosen by applying neutral search keywords to perform a non-biased systematic search, including language variations of terms "cardiac surgery" and "hemoadsorption". The screening and selection process followed scientific principles (PRISMA statement). Abstracts were considered for inclusion if they were written in English and published within the last ten years. Publications were eligible for assessment if reporting on original data from any type of study (excluding case reports) in which a hemoadsorption device was investigated during or after cardiac surgery. Results were summarized according to sub-fields and presented in a tabular view. RESULTS: The search resulted in 29 publications with a total of 1,057 patients who were treated with hemoadsorption and 988 control patients. Articles were grouped and descriptively analyzed due to the remarkable variability in study designs, however, all reported exclusively on CytoSorb$^{®}$ therapy. A total of 62% (18/29) of the included articles reported on safety and no unanticipated adverse events have been observed. The most frequently reported clinical outcome associated with hemoadsorption was reduced vasopressor demand resulting in better hemodynamic stability. CONCLUSIONS: The role of hemoadsorption in cardiac surgery seems to be justified in selected high-risk cases in infective endocarditis, aortic surgery, heart transplantation, and emergency surgery in patients under antithrombotic therapy, as well as in those who develop a dysregulated inflammatory response, vasoplegia, or septic shock postoperatively. Future large randomized controlled trials are needed to better define proper patient selection, dosing, and timing of the therapy

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001).ConclusionIn a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines

Traitement chirurgical de la fibrillation auriculaire au CHU d'Angers (Analyse rétrospective de la récupération du rythme sinusal après intervention de Cox-Maze unilatéral gauche ou radiofréquence)

ANGERS-BU Médecine-Pharmacie (490072105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

L'intégration de la lecture critique d'article dans l'Examen National Classant de médecine vue au travers d'une promotion d'étudiants angevins

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Evaluation de la production scientifique issue des thèses de médecine soutenues à la faculté d 'Angers entre 2002 et 2008

ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Evaluation de la production scientifique issue des mémoires de DES et DESC soutenus à la faculté d'Angers entre 2002 et 2008

Le mémoire, indispensable dans la validation des études spécialisées, représente, comme la thèse, l accès ordinal à l exercice de la profession de docteur en médecine spécialisée. Après avoir recensé tous les mémoires à l'aide d'un questionnaire adressé aux 373 étudiants concernés par l'enquête, l étude a évalué, à travers une base de données biomédicale, le nombre de publications issues de ces mémoires ainsi que son rôle dans la production scientifique globale du CHU via SIGAPS. Les freins à la publication ont été étudiés à travers une enquête rétrospective d'opinion. Après avoir extrait de cette enquête la part réelle des nouveaux travaux (mémoire rédigé, soutenu et indépendant de la thèse) les publications ont été recherchées dans les bases de données Medline via Pubmed, I.S.I. Web of Knowledge et dans SIGAPS de l établissement. Les résultats de cette étude ont été présentés à travers une analyse statistique descriptive. Près de 85% des mini-questionnaires ont été rempli permettant de créer, sur la faculté d Angers, la première base de données répertoriant les mémoires de DES et DESC soutenus entre 2002 et 2008. Sur cette période, 202 nouveaux travaux ont été analysés, 50 articles issus de ces mémoires ont été indexés Pubmed. La participation de ces nouveaux travaux à la production scientifique de l établissement et donc à son financement à travers les MERRI reste faible puisqu'elle ne représente que 1,9% du score SIGAPS, les freins soulevés par l'enquête (manque de motivation de l'étudiant, manque de temps, manque d'intérêt medical à sa publication) font évoquer la création d'une cellule de soutien logistique institutionnel pouvant faciliter l'accès à la publication.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

La question de la pulsatilité de l'écoulement sanguin lors d'une chirurgie cardiaque avec circulation extra-corporelle: un défi technologique?

International audienc

Extracorporeal circulation during on‐pump cardiac surgery: an evaluation of the Energy Equivalent Pressure (EEP) index based on waveforms decomposition in harmonics

The use of pulsatile perfusion (PP) instead of Non-Pulsatile Perfusion (NP) during cardiopulmonary bypass (CPB) continues to be a source of debate. The disagreements among the conclusions of the published studies may be due to different factors: differences in the type of patients included in the studies, differences in the protocol of the studies and difficulty to quantify the pulsatility of the flow. In the present paper, we propose a quantitative evaluation of Shepard's EEP index, based on the harmonic decomposition of the physiological aortic pressure and flow rate signal. It is thus demonstrated that the surplus energy provided by pulsatile flow remains moderate (of order 10 mmHg), but that it can be improved by changing the relative shapes of the pressure and flow waves