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Vessel Plus 2021;5:[Accepted].10.20517/2574-1209.2021.61@The Author(s) 2021
Accepted Manuscript
Open AccessReview

Cytosorb© haemoadsorption: a potential game changer for patients needing myocardial surgical revascularisation


Correspondence Address: Dr. Nandor Marczin, Department of Anaesthesia Harefield Hospital, Harefield Middlesex, UB9 6JH, UK. E-mail: n.marczin@imperial.ac.uk

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© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Abstract

Cytosorb, an extracorporeal blood purification system, utilises the principles of haemoadsorption to remove low molecular weight substances from the blood, including multiple cytokines such as interleukin (IL)-1b, IL-6, IL-8 and tumour necrosis factor (TNF)-a, and anti-platelet drugs aiming to improve clinical outcomes. Given the prominent role of pro-inflammatory cytokines in various inflammatory states, Cytosorb has seen growing application as a therapeutic immunomodulator including surgery. This review focuses on the effects of the use of Cytosorb in patients undergoing coronary artery bypass grafting (CABG) and the indications of removal of cytokines and anti-platelet agents such as ticagrelor. The evidence supports the feasibility and safety profile of Cytosorb, with no device-related adverse events reported in all studies. Initial studies suggest significant potential for Cytosorb in urgent or emergency CABG surgery to remove anti-platelet medication with promising benefits on clinical outcomes including fewer blood product transfusions, decreased length of intensive care unit stay and lower re-sternotomy rates. Furthermore, a cost saving analysis indicated that intraoperative removal of ticagrelor with Cytosorb would be cost effective in the setting of emergency cardiac surgery. However, the evidence remains inconclusive when Cytosorb is used in elective CABG surgery for cytokine removal. Definite high quality clinical trials for both indications for Cytosorb in CABG surgery are needed to clarify if there is a clinically significant benefit in clinical outcomes. There is substantial trial activity for the application of Cytosorb in higher risk cardiac surgery to establish the place of Cytosorb in future treatment pathways in cardiac surgery.

Cite This Article

Ng Yin Ling C, Umakumar K, Moss L, Stock UA, Raja SG, de Waal EEC, Marczin N. Cytosorb© haemoadsorption: a potential game changer for patients needing myocardial surgical revascularisation. Vessel Plus 2021;5:[Accept]. http://dx.doi.org/10.20517/2574-1209.2021.61

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