Molecular adsorbents recirculating system dialysis for liver insufficiency and sepsis following right ventricular assist device after cardiac surgery.
We report a case of right heart failure (RHF) and sepsis with liver insufficiency in a 70-year-old patient after coronary artery bypass graft surgery. Three hours after surgery the patient suddenly developed therapy refractory cardiac arrest caused by RHF. He had to have emergency surgery, under which the graft to the right coronary artery was revised and a right ventricular assist device was implanted. Heart function recovered and the assist device was explanted on day 1 after surgery. Thoracic closure was performed on day 5 after surgery. The patient went into septic shock on day 11. Liver dysfunction developed postoperatively and worsened the course of sepsis. Therefore, MARS (molecular adsorbents recirculating system) dialysis was performed once on day 20 after surgery. Liver function improved after MARS therapy and the patient recovered from sepsis. On day 46 the patient was transferred from the ICU of another hospital to one of the peripheral wards, to be finally discharged on day 67.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Humboldt-University of Berlin, Berlin, Germany. otrud.vargas@charite.de
Otrud Vargas
OV
Hein
Susanne
S
Marz
Wolfgang
W
Konertz
Wolfgang J
WJ
Kox
Claudia
C
Spies
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003956:Dialysis / Q000295:instrumentation; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000628:therapy*; D019164:Liver, Artificial; D008297:Male; D012772:Shock, Septic / Q000209:etiology; D016060:Sorption Detoxification / Q000295:instrumentation*