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Cardiovascular

Protect your cardiovascular patients

Complex cardiac surgeries with use of CPB can result in a dysregulated immune response with clinical complications like vasoplegic shock and multi-organ dysfunction syndrome. Emergency cardiac surgeries in patients on antithrombotic drugs such as ticagrelor or rivaroxaban can result in severe bleeding complications.

  • Intraoperative

    The use of CytoSorb® during surgery is intended to prevent postoperative hyperinflammation and its complications, or to remove ticagrelor and rivaroxaban in order to reduce the bleeding risk.

    Re-balancing the immune response and reducing or preventing the related damage is prudent in very complex procedures, such as heart transplantation or aortic surgery, or in cases of infective endocarditis surgery, when the immune system is already activated and there is a high risk for further activation during surgical intervention. Intraoperative use of CytoSorb is then meant to help improve hemodynamic stability and postoperative outcomes.

  • Postoperative

    In the postoperative setting, our innovative CytoSorb technology works quickly to support shock reversal – a vital, life-saving measure needed to avoid the devastating effects of ongoing systemic hyperinflammation causing severe hemodynamic instability, eventually resulting in multi-organ failure.

    Boss K et al., PLoS One 2021; 16(2):e0246299

CytoSorb can be applied in various cardiovascular indications

Antithrombotics Infective endocarditis Aortic surgery Heart failure Postoperative hyperinflammation ECMO

Safeguard urgent surgeries against bleeding risks

Interoperative use of CytoSorb swiftly removes antithrombotic agents, reducing bleeding complications in urgent surgeries and enhancing patient safety.

Master bleeding risks

In case of urgent or emergency surgery with no time to wait, antithrombotics can lead to an increase in perioperative bleeding. CytoSorb has been shown to be safe and effective for intraoperative antithrombotic drug removal.

 

When it comes to cardiac surgery, the underlying pathology, the complexity of the surgical procedures, and the urgent or emergent need for surgery mean there is an inherently higher risk of perioperative bleeding. The use of DOACs like e.g. rivaroxaban and the anti-platelet agent ticagrelor pose an even higher additional risk of bleeding if drug washout is not possible.

By removal of ticagrelor and rivaroxaban during cardiopulmonary bypass surgery, CytoSorb has been shown to support faster patient recovery by reducting perioperative bleeding:

Reduced operation time
Reduced RBC transfusion
Reduced PLT transfusion
Reduced re-thoracotomy rates
Reduced ICU length of stay
Reduced drainage volume
Drainage volume
CytoSorb® provides significant reduction in drainage volume Drainage volumne

The 24-hours drainage volume was significantly lower in adsorber-treated patients; patients on with ticagrelor and rivaroxaban and with (right side) and without (left side) hemadsorption.

Hassan K et al., Ann Thorac Cardiovasc Surg. 2022 28(3):186-192

Cost effectiveness

CytoSorb Therapy provides significant cost savings over standard of care across several healthcare systems (1-2)

Healthcare system
Overall cost saving vs Standard of care £3,941 (1) €4,200 ± 1,100 (2)
    1. Javanbakht et al., Pharmacoecon Open 2020; 4(2):307-319
    2. Hassan et al., Presented at ESC Congress, Barcelona Spain, August 2022: 1279

Best practice therapy management

  • Therapeutic goal

    Reduction of bleeding complications, blood product use, and length of ICU stay

  • Patient selection

    Patients undergoing cardiac surgery who were pretreated with ticagrelor and / or rivaroxaban, with last dose of Ticagrelor < 72 hrs. and Rivaroxaban < 48 hrs.

  • Timing

    Start therapy with the start of CPB. CytoSorb® is easily integrated into the CPB circuit (post-pump to venous reservoir)

  • Dosing

    Postoperative continuation (with a new adsorber integrated into an extracorporeal circuit) is normally NOT needed if CPB time > 60 min, but can be done if needed.

Protect your surgical outcomes

Major surgery with CPB poses the risk of postoperative complications related to hyperinflammation. Intraoperative use of CytoSorb is intended to remove excessive levels of cytokines, thereby preventing these complications.

Stabilize your infective-endocarditis patients

 

Despite being a curative therapeutic approach, infective-endocarditis surgery carries the risk of bacterial spread and further activation of the immune system, resulting in severe hemodynamic instability and further complications like multi-organ failure.
CytoSorb has been shown to effectively and safely reduce elevated levels of cytokines in infective-endocarditis patients.

By removal of elevated cytokines, CytoSorb Therapy can help to safely manage infective endocarditis patients through reduction in perioperative bleeding:

Promotion of hemodynamic stability
Reduction in length of ICU stays
Reduction in vasopressors needs
Reduction in vasopressors needs
Haidari Z et al., Ann Thorac Surg 2020; 110(3):890-896
Reduction in sepsis and sepsis-related mortality
Reduction in sepsis and sepsis-related mortality
Kalisnik JM et al., J Clin Med. 2022;11(14):3954
Reduction in mortality in patients infected with Staphylococcus aureus
Reduction in mortality in staph aureus patients
Haidari et al., ICV&TS 2023; 36(1):ivad010

Best practice therapy management

  • Therapeutic goal

    Stabilization of hemodynamics, reduction of sepsis-related mortality, protection of organ function

  • Patient selection

    CytoSorb Therapy may be considered during cardiac surgery for acute/active high-risk IE. Additional criteria for clinical use of CytoSorb intraoperatively in IE patients may be the following:

    • Fever
    • Highly elevated inflammatory parameters
    • Hemodynamic instability requiring high vasoactive support
    • Staphylococcus aureus as pathogen
  • Timing

    Start therapy with the start of CPB. CytoSorb is easily integrated into the CPB circuit (post-pump to venous reservoir)

  • Dosing

    Consider postoperative continuation of CytoSorb Therapy (with a new adsorber integrated into an extracorporeal circuit) in IE patients when the following signs are observed intraoperatively:

    • Development of intraoperative oliguric/anuric renal failure
    • Increased norepinephrine/vasopressin requirements
    • High-grade intraoperative findings (vegetations and aortic root abscess)

Protect aortic surgery patients

 

Complex cardiac surgeries like aortic surgery can result in a dysregulated immune response with clinical complications such as vasoplegic shock or multi-organ failure.

 

CytoSorb has been shown to reduce elevated levels of cytokines to promote hemodynamic stability and protect aortic surgery patients from hyperinflammation risk.

CytoSorb Therapy can help to:

Attenuate hyperinflammation
Improve pulmonary function
Promote hemodynamic stability
Perioperative vasopressor therapy
Saller T et al., Eur J Cardiothorac Surg 2019; 56(4):731-737
Reduce blood product use
Reduce blood product use
Saller T et al., Eur J Cardiothorac Surg 2019; 56(4):731-737
Reduce vasopressor needs
Perioperative vasopressor therapy
Saller T et al., Eur J Cardiothorac Surg 2019; 56(4):731-737

Best practice therapy management

  • Therapeutic goal

    Reduction of complications through:

    • Stabilization of hemodynamics
    • Reduction of bleeding risks
    • Support of the respiratory function
  • Patient selection

    CytoSorb Therapy may be considered during cardiac surgery in complex aortic surgery. Additional criteria for clinical use of CytoSorb intraoperatively in aortic surgery patients may be the following:

    • High preoperative lactate
    • Planned deep hypothermic circulatory arrest
    • Planned cerebral perfusion
    • Hemodynamic instability requiring high vasopressor support
  • Timing

    Start therapy with the start of CPB. CytoSorb is easily integrated into the CPB circuit (post-pump to venous reservoir)

  • Dosing

    Consider postoperative continuation of CytoSorb Therapy (with a new adsorber integrated into an extracorporeal circuit)

    • Development of intraoperative oliguric /anuric renal failure
    • Increased norepinephrine /vasopressin requirements
    • Unexpected intraoperative findings e.g. long visceral ischemia

Stabilize your heart failure patients

Heart failure patients carry a high risk of developing cardiogenic shock, which, like other states of hypoperfusion, can trigger the immune system and result in a dysregulated immune response with vasoplegic shock and further severe clinical consequences. Patients undergoing orthotopic heart transplantation are among the highest risk for perioperative vasoplegic syndrome.

 

CytoSorb has been shown to reduce elevated levels of cytokines to help stabilize heart failure patients.

CytoSorb Therapy can help to:

Promote hemodynamic stability
Reduce the need for postoperative dialysis (heart transplantation)
Reduce the need for postoperative dialysis (heart transplantation)
Vasoactive inotropic score during 24h after heart transplantation

Major components of vasoactive inotropic score during the first 24 h after orthotopic heart transplantation. Noradrenaline (A); Argipressin (B); Dobutamine (C); Milrinone (D). N=55. Data are presented as medians and 95% confidence intervals.

E. Nemeth et al., ESC Heart Failure 2024;11(2):772–782
Reduce vasopressor needs

Control postsurgical hyperinflammation

In a postoperative setting, our innovative CytoSorb technology works quickly to support shock reversal – a vital, life-saving measure needed to avoid the devastating effects of ongoing systemic hyperinflammation causing severe hemodynamic instability, eventually resulting in multi-organ failure.

Stabilize hemodynamics

An uncontrolled inflammatory response after surgery plays a significant role in post-op morbidity or mortality, contributing to vasoplegic shock and multi-organ dysfunction.

 

CytoSorb has been shown to effectively and safely reduce elevated levels of cytokines to help control postsurgical hyperinflammation and improve hemodynamic stability.

The use of CytoSorb Therapy can help safely manage the risks associated with hyperinflammation, resulting in:

Attenuation of hyperinflammation
Promotion of hemodynamic stability and shock reversal
Noradrenalin and adrenalin requirement
Promotion of hemodynamic stability and shock reversal Boss K et al., PLoS One 2021; 16(2):e0246299
Improvement of micro- and macro-circulation
Reduction in vasopressors
Noradrenalin and adrenalin requirement
Promotion of hemodynamic stability and shock reversal Boss K et al., PLoS One 2021; 16(2):e0246299

Best practice therapy management

  • Therapy Goal

    To stabilize hemodynamics and reduce mortality risk

  • Patient selection
    • Refractory septic/vasoplegic shock
    • High (and increasing) need for vasopressors
    • No (proper) response to standard of care
    • Biomarkers (if available): IL-6 > 500 pg/mL, PCT > 3 µg/L, ferritin > 1000 µg/L
  • Timing
    • < 24 hours after diagnosis / start of standard therapy
    • Do not wait until lactate is > 6.5 / 7 mmol/L
  • Dosing
    • Continue until sufficient hemodynamic stabilization is achieved
    • Change after 12 hours if instability persists

Support your ECMO patients

ECMO patients have a high risk of concomitant hyperinflammation. Either the underlying disease leading to the need for ECMO is associated with hyperinflammation, or the extracorporeal circuit can trigger it.

ECMO with CytoSorb

ECMO is increasingly used in ARDS and cardiogenic shock, but morbidity and mortality rates remain high.

 

Treatment options to enhance the clinical benefits of ECMO support and prevent complications, such as ongoing hyperinflammation, are currently limited.

 

CytoSorb is intended to modulate an accompanying or triggered immune response by removal of elevated levels of cytokines and thus aims to increase the chances of recovery.

Enhance VA-ECMO Outcomes

Venoarterial (VA) ECMO supports the normalization of macro-circulatory hemodynamics and fluid balance, but mechanical circulatory support itself can introduce stress, which negatively impacts on micro-circulatory function. CytoSorb accelerates the stabilization of hemodynamics in VA-ECMO patients, promoting organ recovery.

Sequential Organ Failure Assessment (SOFA) Score

Soltesz et al., J Clin Med 2022; 11(21):6517

Vasoactive Inotropic (VIS) Score

Soltesz et al., J Clin Med 2022; 11(21):6517

Support VV-ECMO patients

VV-ECMO in Critical Care

Additional Information

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Recommended literature
Recommended literature
Flowchart Recommended literature
Recommended literature
Flowchart Evolution of evidence Recommended literature
  • Rugg et al., Biomedicines 2020; 8(12):539
  • Akil et al., Thorac Cardiovasc Surg 2021; 69(3):246-251
  • Holmen et al., J Cardiothorac & Vasc Anesth 2022; 36(8 Pt B):3015-3020
  • Boss et al., PLoS One 2021; 16(2):e0246299
  • Bernardi et al., Crit Care 2016; 20(1):96
  • Poli et al., Crit Care 2019; 23:108
  • Gleason et al., Sem Thorac Cardiovasc Surg 2019; 31(4):783-793
  • Diab et al., 2022; 145(13):959-968
  • Angheloiu et al., JACC Basic Transl Sci 2017; 2(2):135-145
  • Koertge et al., Blood Purif 2018; 45(1-3):126-128
  • Haidari et al., Ann Thorac Surg 2020;110(3):890-896
  • Traeger et al., Int J Artif Organs 2017; 40(5):240-249
  • Bottari et al., Int J Art Organs 2020; 43(9):587-593
  • Hassan et al., Annals of Thoracic Surg 2019; 108(1):45-51
  • Hassan et al., Ann Thorac Cardiovasc Surg 2022;28(3):186-192
  • Javanbakht et al., PharmacoEconomics Open 2020; 4:307-319
  • NICE Medtech innovation briefing, February 2021; www.nice.org.uk/guidance/mib249
  • Haidari et al., Ann Thorac Surg 2020; 110(3):890-896
  • Kalisnik et al., J Clin Med. 2022;11(14):3954
  • Haidari et al., PLoS One 2022;17(7):e0266820
  • Traeger et al., Int J Artif Organs 2017; 40(5):240-249
  • Kuehne et al., Int J Artif Organs 2019;42(4):194-200
  • Saller et al., Eur J Cardiothorac Surg 2019; 56(4):731-737
  • Nemeth et al., J Clin Trans 2018; 32(4):e13211
  • Calabrò et al., Artif Organs 2019; 43(2):189-194
  • Traeger et al., Int J Artif Organs 2020; 43(6):422-429
  • Soltesz et al., J Clin Med 2022; 11(21):6517
  • Akil et al., J Clin Med 2022; 11(20):5990
  • Hayanga et al., Int Care Med Exp 2022; 10(40):494
  • Nemeth et al., ESC Heart Fail 2024;11(2):772-782
  • Hassan et al., JTCVS Open 2023;15:190-196
  • Schmoeckel et al., J Thromb Thrombolysis 2024; epub (doi; 10.1007/s11239-024-02996-x)
  • Cohen et al., Am J Cardiovasc Drugs 2023; 23(4):429-440
  • Cao et al., Eur Heart J 2023; 44(20):1780-1794
  • Singh et al., Am J Case Rep 2023; 24:e940383
  • Mehta et al., Interdiscip Cardiovasc Thorac Surg 2024; 38(4):ivae050
  • Naruka et al., Heart Lung Circ 2022; 31(11):1493-1503
  • Mehta et al., Cardiothorac Vasc Anesth 2021; 35(2):673-675
  • Doukas et al., J Clin Med 2023; 12(2):546
  • Haidari et al., ICV&TS 2023; 36(1):ivad010
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Access Healthcare Professionals Area

This area is for Health Care Professionals only and provides reports about clinical experiences gained during the use of CytoSorbents products. The information presented reflects the opinions and procedural techniques of individual physicians and is not intended as medical advice. Physician experience, risks, patient outcomes and results may vary.