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Intraoperative endotoxin adsorption as a new therapeutic option for mycotic aortic aneurysm

Toshinori Totsugawa1, Masahiko Kuinose, Hidenori Yoshitaka

  • 1Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan. toshinoritotsugawa@mac.com

Circulation Journal : Official Journal of the Japanese Circulation Society
|December 27, 2007
PubMed

Insights

This study shows that intraoperative endotoxin adsorption using polymyxin B-immobilized fiber (PMX-DHP) can stabilize hemodynamics and improve oxygenation in patients with mycotic aortic aneurysms, aiding surgical recovery.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Mycotic aortic aneurysms are life-threatening infections requiring complex surgical management.
  • Sepsis and hemodynamic instability pose significant risks during surgical repair of these aneurysms.

Observation:

  • An 82-year-old male with a distal arch mycotic aortic aneurysm presented with sepsis, necessitating urgent surgical intervention.
  • The surgical procedure involved excision of the infected aorta, replacement with a rifampicin-bonded graft, and omental coverage.

Findings:

  • Intraoperative direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP) was performed concurrently with the cardiopulmonary bypass circuit.
  • PMX-DHP significantly reduced plasma endotoxin levels, improved hemodynamic stability, and enhanced oxygenation.
  • These effects facilitated a smooth weaning process from cardiopulmonary bypass.

Implications:

  • Intraoperative endotoxin adsorption via PMX-DHP is a technically straightforward and effective adjunctive therapy for mycotic aortic aneurysms.
  • This approach offers a potential new therapeutic strategy for stabilizing patients during complex aortic surgeries.
  • PMX-DHP may improve outcomes by mitigating the systemic inflammatory response associated with these infections.

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