Cardiac surgery and acute hepatitis B - Use of the Seraph™ 100 hemofilter

We present a case of a 55-year-old male, presenting with angina symptoms with electrocardiographic changes and a panfocal systolic murmur radiating to the carotids. He had a primary HBV infection 8 months ago, without antiviral treatment. Echocardiography showed critical aortic valve stenosis (area: 0.53 cm2/m2). No coronary lesions were found on coronary angiography. Blood analysis revealed AST/GOT of 96 U/L and ALT/GPT 150 U/L. The serological profile revealed positive IgM anti-HBc, anti-HBc, anti-HBs and anti-HBe antibodies, with an increasing viral load (VL). The abdominal ultrasound identified mild hepatic fibrosis (F3) with minimal steatosis. Mechanical aortic prosthetic valve replacement was performed under CPB. The Seraph™ 100 filter was incorporated into the CPB circuit to reduce the risk of HBV contamination, infection and liver failure. The postoperative VL was monitored (Table 1). Liver function tests showed peak levels of bilirubin 0.66 mg/dL, AST/GOT 58 U/L, ALT/GPT 74 U/L at 6 hours post-surgery, with recovery of normal ranges at 48 hours post-surgery.