Intraoperative direct hemoperfusion with a polymyxin-B immobilized fiber column for treatment of infective endocarditis

Purpose. Endotoxin adsorption treatment (direct hemoperfusion using a polymyxin-B immobilized fi ber column, or PMX-DHP) is now considered a useful option for treating severe sepsis. However, the effi cacy of PMX-DHP for infective endocarditis (IE), in which the causative microorganisms are usually Gram-positive cocci, remains unclear. In the present study, we investigated the impact of intraoperative PMX-DHP on clinical parameters during the treatment of IE. Methods. From November 2006 to December 2009, a total of 11 patients with active IE underwent emergent surgery using intraoperative PMX-DHP. The perioperative courses of these patients were compared with those of seven patients who underwent emergent surgery for active IE with the conventional method from January 2003 to October 2006. Results. PMX-DHP was associated with a signifi cant decrease in the postoperative catecholamine dose and duration. Intubation time and intensive care unit length of stay for the PMX-DHP group was significantly shorter than that for the conventional therapy group. There was also a significant difference in the number of failed organs postoperatively between the two groups. Conclusion. Intraoperative PMX-DHP demonstrated several positive effects, such as a drastic decrease in the doses of inotropic agents and shortening of the duration of mechanical ventilation, in patients who underwent emergent surgery for active IE. Intraoperative PMX-DHP can be a useful option for the treatment of critically ill patients with IE. © The Japanese Association for Thoracic Surgery 2011.