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Doukas P, Hellfritsch G, Wendt D, Magliani M, Barbati ME, Jalaie H, Jacobs MJ, Gombert A. Intraoperative Hemoadsorption (Cytosorb™) during Open Thoracoabdominal Aortic Repair: A Pilot Randomized Controlled Trial. J Clin Med 2023; 12:546. [PMID: 36675474 PMCID: PMC9866403 DOI: 10.3390/jcm12020546] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The efficacy of cytokine adsorption in controlling the early inflammation cascade after open thoracoabdominal aortic (TAAA) repair has not been investigated. The aim of this pilot randomized controlled trial was to assess the feasibility and effect of perioperative hemoadsorption during open TAAA repair. METHODS Patients scheduled for open TAAA repair with the use of cardiopulmonary bypass (CPB) were included. The patients were randomized the day before surgery to either intraoperative hemoadsorption during CPB or standard of care. RESULTS A total of 10 patients were randomly assigned to the intervention group, whereas the control group consisted of 17 patients (mean age of the total cohort, 51.1 ± 11.2 years, 67% male, 3 patients not randomized). The majority of baseline and perioperative characteristics were similar, and no device-related adverse events were reported. A trend to shorter ventilation times in the intervention group was observed (median 88 h vs. 510 h, p = 0.08, Δ422). Severe acute respiratory distress syndrome was significantly less in the intervention patients (p = 0.02). CONCLUSIONS This is the first pilot study showing that the intraoperative use of hemoadsorption in open TAAA repair patients may be feasible and safe, yet larger trials are needed to evaluate whether intraoperative hemoadsorption is associated with improved clinical outcomes.
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Affiliation(s)
- Panagiotis Doukas
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Gabriel Hellfritsch
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Daniel Wendt
- Westgerman Heart & Vascular Center, University Hospital Essen, 45147 Essen, Germany
- CytoSorbents Inc., Princeton, NJ 08540, USA
| | - Mirko Magliani
- Department of Cardiothoracic Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Mohammad E. Barbati
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Houman Jalaie
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Michael J. Jacobs
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
| | - Alexander Gombert
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, 52074 Aachen, Germany
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Chatterjee S, Preventza O, Orozco-Sevilla V, Coselli JS. Perioperative management of patients undergoing thoracic endovascular repair. Ann Cardiothorac Surg 2021; 10:768-777. [PMID: 34926179 DOI: 10.21037/acs-2021-taes-74] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/25/2021] [Indexed: 11/06/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is a less invasive method for treating thoracic and some thoracoabdominal aortic aneurysms, dissections of the thoracic aorta and blunt traumatic aortic injury, compared with conventional open surgery. Maximizing the likelihood of a successful outcome requires diligent multidisciplinary (surgical, critical care, nursing, pharmacy, nutrition and physical therapy) perioperative care. In this article, we discuss fundamentals for managing patients after endovascular aortic aneurysm repair. These principles focus on the transition between the operating room and the intensive care unit, prevention and management of spinal cord deficits (SCD), and vital neurological, respiratory, cardiovascular, renal, gastrointestinal and hematological concerns. The better the care team understands the expected postoperative course, the earlier that deviations can be recognized and the more likely that successful rescue can be achieved to reduce the incidence and severity of adverse outcomes. Achieving optimal results after TEVAR requires attention to detail across the preoperative, intraoperative and postoperative phases of care.
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Affiliation(s)
- Subhasis Chatterjee
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
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3
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Sarridou DG, Boutou A, Mouratoglou SA. The role of a successful analgesia plan for thoraco-abdominal aneurysm repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:653-654. [PMID: 34142525 DOI: 10.23736/s0021-9509.21.11973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Despoina G Sarridou
- Department of Cardiac and Vascular Anaesthesia, General Hospital "G. Papanikolaou, " Thessaloniki, Greece -
- Department of Anesthetics, Guy's and St. Thomas' NHS Foundation Trust, London, UK -
| | - Afroditi Boutou
- Department of Respiratory Medicine, General Hospital "G. Papanikolaou, " Thessaloniki, Greece
| | - Sophia A Mouratoglou
- Intensive Care Unit, Department of Anesthesiology and Intensive Care, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
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