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Experience with IgM-Enriched Immunoglobulins as Adjuvant Therapy in Septic Patient after Redo Cardiac Surgery

Vera Maravic-Stojkovic, Milja Tanasic, Branko Calija, Ljiljana Lausevic-Vuk, Ivan Stojanovic, and Miomir Jovic

Infective endocarditis after combined mitral valve repair and coronary artery bypass surgery, multi-organ failure and sepsis, were treated with mitral valve replacement, antibiotics and adjunctive therapy. Sepsis caused by Gramnegative bacteria, was identified based on the grave clinical status, hemodynamic findings and high levels of proinflammatory cytokines. On the day of the redo surgery, the APACHE II and SOFA scores were 26 and 14, respectively. The IgM-enriched immunoglobulin Pentaglobin® was administered on the first postoperative day after redo procedure. The cardiac index improved from 1.9 L/m2 to 3.7 L/m2 on the 1st postoperative day, accompanied with increasing values of mixed venous oxygen saturation from 59.3% to 77%, while systemic vascular resistance 887 dyn·s/cm5 was maintained by vasopressor agent. On the 4th postoperative day the inotropes and pressors ceased. The acute physiology and chronic health evaluation (APACHE II) score and sequential organ failure assessment (SOFA) score decreased to 10 and 2, respectively. The prompt improvement in patient’s general clinical condition, stabilised hemodynamic parameters, balanced perfusion and oxygen pattern, accompanied by notable reduction of pro-inflammatory cytokine expression, were the outcome of the presented therapeutic approach.