Intravenous Immunoglobulin Administration in Cardiac Surgery, Heart Transplantation and Infective Endocarditis: A...

Perioperative infections are a common cause of morbidity in cardiac surgery. Intravenous immunoglobulin (IVIG) is increasingly used as a rescue treatment for septic shock. However, data on efficacy and safety in cardiac surgery patients are limited. A scoping review of available literature aimed at identifying studies investigating the use of IVIG in patients undergoing cardiac surgery or with infective endocarditis was performed. Studies reporting data on the use of IVIG in these populations were included, including case reports. Data on study design, population, control group, indications for IVIG therapy, and formulation and dose of IVIG were abstracted. Outcome data from randomized controlled trials (RCTs) were also abstracted. A total of 135 studies were identified, including 7 RCTs and 1 RCT study protocol. Most studies were performed in the setting of heart transplantation, followed by nontransplant cardiac surgery and infective endocarditis. The most common formulation was standard IVIG at a dose of 2 g/kg. Available data on the use of IVIG in cardiac surgery patients are mostly limited to the use of standard IVIG in heart transplantation recipients, and available evidence does not justify the routine use of IVIG in the cardiac surgery setting. However, in light of the strong scientific rationale supporting the use of IVIG, new high-quality RCTs enrolling a larger number of patients and following prospectively registered protocols are needed.