Effect of haemoadsorption during cardiac surgery for Staphylococcus aureus endocarditis: a REMOVE trial post hoc analysis
Authors: Caldonazo Tulio , Van den Eynde Jef , Doenst Torsten , Kirov Hristo , Franz Marcus , Hagel Stefan , Lehmann Thomas , Diab Mahmoud ,   the REMOVE Trial Investigators, Diab Mahmoud , Lehmann Thomas , Bothe Wolfgang , Akhyari Payam , Platzer Stephanie , Wendt Daniel , Deppe Antje-Christin , Strauch Justus , Hagel Stefan , Günther Albrecht , Faerber Gloria , Sponholz Christoph , Franz Marcus , Scherag André , Velichkov Ilia , Silaschi Miriam , Fassl Jens , Hofmann Britt , Lehmann Sven , Schramm Rene , Fritz Georg , Szabo Gabor , Wahlers Thorsten , Matschke Klaus , Lichtenberg Artur , Pletz Mathias W , Gummert Jan F , Hagl Christian , Borger Michael A , Bauer Michael , Brunkhorst Frank M , Doenst Torsten , Schiller Isabella , Winter Marcus , Eichhorn Cornelia , Helbig Aicko , Rißner Florian , Abdyvasiev Kubanychbek , Moschovas Alexandros , Freiburger Sebastian , Safarov Rauf , Bargenda Steffen , Kirov Hristo , Richter Markus , Sandhaus Tim , Zeynalov Natig , Kaluza Mirko , Bösemann Denis , Boog Swen , Ostermann Romanus , Schulze P Christian , Hamadanchi Ali , Musleh Rita , Witte Otto W , Bloos Petra , Schwope Katrin , Kolanos Steffi , Knuhr-Kohlberg Karina , Haucke Anja , Lehmann-Pohl Katja , Weber Carolyn , Cizmic Amila , Grathwohl Corinna , Sindhu Dirk , Schaschek Markus , Baier Axel , Schaub Sebastian , Großkurth Uwe , Herré Eranya Sone , Vlasov Andrey , Podanev Dimitry , Plettenberg Tobias , Mühlbauer Thomas , Tunggal Irawati , Eichler Madlen , Cosic Jasmina , Wolf Vera , Krause Petra , Krischer Stephanie , Thielmann Matthias , Wiese Ingo , Hillmer Tobias , von Manstein Jörg , Deus Markus , Ljesic Dusko , Roloff Daniel , Ristau Tim Alabowicz Wolfgang , Spangel Gina , Kroll Johannes , Ballazhi Fatos , Kondov Stoyan , Siepe Matthias , Rylski Bartosz , Scheumann Johannes , Inka Matthias D′ , Eschenhagen Matthias , Al-Hamami Yasir , Bauer Nils , Thoma Martin , Rambach Albena , Ziemann Christian , Garcia Gustavo Fernandez Baca , Morlock Julia , Benk Christoph , Klink Alina , Maltes Christoph , Lechner Gabriele , Blümel Veronika , Heizmann Ulrike , Kotzjan Priscilla , Haldenwang Peter , Elghannam Mahmoud , Useini Dritan , Buchwald Dirk , Buchwald Bärbel , Schröter Thomas , Binner Christian , Hartung Philipp , Holzhey David , Misfeld Martin , Etz Christian , Davierwala Piroze , Leontyev Sergey , Pfannmüller Bettina , Garbade Jens , von Aspern Konstantin , Saeed Diyar , Aydin Muhammed , Herzfeld Jonathan , Feder Stefan , Kiefer Philipp , Meyer Anna , Seeburger Joerg , Münch Philipp , Prehl Jörg , Ginther René , Koch Josephine , Hecht Salome , Winkler Hannes , Fritzsche Berit , Winata Johann , Schmidt Julia , Labus Jakob , Frei Isabell , Schmidt Volker , Plötze Katrin , Schal Susanne , Immohr Moritz , Sugimura Yukiharu , Gietmann Anne , Simm Andreas , Höpfner Florian , Stiller Markus , Ludwig Kathrin , Helms Sven , Sunavsky Jakub , Götte Julia , Rudloff Markus , Schönbrodt Andrea , Fink Swetlana , Albrecht Ina-Maria , Nnanga Alice Huguette Minko , Schneider Carola , Schilling Heike , Maier Tanja , Kühnel Ralf-Uwe , Ioannou Stelios , Necaev Anna-Maria , Müller Torsten , Bienek Ralph , Treede Hendrik , Kohistani Zaki , Ahmadpour Touraj , Friese Sonja , Oberbach Andreas , Luehr Maximilian , Joskowiak Dominik , Büch Joscha 
Published: March 2024

Abstract

OBJECTIVES
Multi-organ failure is one of the leading causes of mortality after cardiac surgery for infective endocarditis (IE). Although the randomized evidence does not support the use of haemoadsorption during cardiac surgery for IE, observational studies suggest a beneficial effect in selected patient groups. Staphylococcus aureus is the most common pathogen, and its presence is an independent mortality predictor. We aimed to analyse the effect of haemoadsorption in patients with IE caused by S. aureus.

METHODS
This is a post hoc analysis of the REMOVE trial that randomized 288 patients with IE who underwent cardiac surgery with haemoadsorption using CytoSorb® or control. The primary outcome was ΔSequential Organ Failure Assessment (SOFA), defined as the difference between the mean total postoperative and baseline SOFA score within 24 h of surgery.

RESULTS
Among the total of 282 patients included in the modified intention-to-treat analysis of the REMOVE trial, 73 (25.9%) had S. aureus IE (38 patients in the haemoadsorption group and 35 patients in the control group). The overall ΔSOFA did not differ between the intervention groups in patients with S. aureus IE (mead difference = −0.4, 95% confidence interval −2.3 to 1.4, P = 0.66) and neither did 30-day mortality (hazard ratios = 1.32, 95% confidence interval 0.53–3.28, P = 0.55). No differences were observed with regard to any of the other secondary outcomes.

CONCLUSIONS
Based on a post hoc analysis from REMOVE trial, the intraoperative use of haemoadsorption in patients with S. aureus IE was not associated with reduction of postoperative organ dysfunction, 30-day mortality or other major clinical end points.