Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement.
OBJECTIVE
The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children.


METHODS
Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring.


RESULTS
Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively.


CONCLUSIONS
In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.
Saatvedt
K
K
Department of Cardiovascular Surgery, Rikshospitalet, University of Oslo, Norway.
Lindberg
H
H
Geiran
O R
OR
Michelsen
S
S
Pedersen
T
T
Seem
E
E
Mollnes
T E
TE
D002315:Cardiopulmonary Bypass; D002648:Child; D015926:Complement C3a / Q000032:analysis; D003179:Complement C3b / Q000032:analysis; D003165:Complement System Proteins / Q000378:metabolism*; D016207:Cytokines / Q000097:blood*; D006439:Hemodynamics; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D011184:Postoperative Period; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014462:Ultrafiltration
D016207:Cytokines; D015850:Interleukin-6; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D015926:Complement C3a; D003179:Complement C3b; D003165:Complement System Proteins