Abstract 3237: A Polymyxin B-Immobilized Hemoperfusion Improve the Surgical Result of Patients With Active Infective Endocarditis
Background: Surgical treatment for active infective endocarditis still remains a challenging and high-risk prodedure. The purpose of this study was to evaluate the efficacy of endotoxin absorption using direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DPH) on patients with active infectious endocarditis.
Methods: Between October 2006 and December 2008, 21 surgically treated patients with active active infectious endocarditis (47.6% prosthetic valve endocarditis) received the endotoxin absorption using PMX-DPH. The mean age was 64±12 years, and 71% were men. Staphylococcus spp. was the most common microorganism. Surgery consisted of valve replacement or repair in patients with infection limited to leaflets of the valve or radical resection of seemingly infected paravalvular tissues, and reconstruction with patches and valve replacement in patients with abscess. PMX-DPH was performed at a blood flow rate of 80 –100ml/min intraoperatively and postoperatively.
Results: Both systolic (100±20 vs 120±26 mmHg, p<0.01) and diastolic (54±10 vs 62±12 mmHg, p<0.05) arterial pressure significantly increased and cardiac index was also significantly increased after PMX-DPH (2.7±0.5 vs 3.2±0.7, p<0.05), despite cathecolamine index significantly decreased (12.0±11.8 vs 6.1±5.2, p<0.05). The mean arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P/F ratio) significantly increased after PMX-DPH therapy (224±76 vs 291±80, p<0.05). Moreover, PMX-DPH significantly reduced serum lactate level (3.2±1.7 vs 2.2±1.6, p<0.05). Moreover, patients with PMX treatment demonstrated significantly higher arterial pressure and P/F ratio after the operation as compared to patients without PMX treatment. Although PMX-DPH treatment did not decrease operative morbidity and mortality, the postoperative hospital stay was significantly decreased by PMX-DPH therapy.
Conclusions: We conclude that PMX-DPH is effective on improvement of postoperative hemodynamic instability and pulmonary oxygenation in patients with active infectious endocardits. It might offer benefit on length of hospitalization in patient with active infective endocarditis.