Conventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart disease.
BACKGROUND
This prospective nonrandomized study is the critical assessment of conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) techniques and their efficiency in congenital heart disease surgeries. Use of cardiopulmonary bypass (CPB) in children is associated with body water retention as a consequence of prime volume and systemic inflammatory reaction. The CUF during CPB has reduced body water excess and the MUF after CPB, removes inflammatory mediators, improves hemodynamic performance, and decreases transfusion requirements.


METHODS
Forty-one patients, aged 9 to 36 months, submitted to surgical correction for cardiac defects, using CPB, were divided into 2 similar groups: CUF (21 patients) operated between 1996-1997 were ultrafiltered during CPB, and CUF+MUF, (20 patients) operated between 1997-1998 and ultrafiltered during and after CPB. Postoperative duration of ventilator support, pediatric intensive care unit stay (PICU), hospital stay of the groups with and without preoperative pulmonary hypertension (PH), as well as transfusion requirement, hematocrit and platelet counts were compared.


RESULTS
There were no technical complications and a significant ultrafiltrate in the CUF+MUF group was observed as compared to the CUF group. No significant differences were observed between the CUF and CUF+MUF groups regarding ventilatory support, PICU stay and hospital stay. Requirements for red cell transfusion, Ht and platelet counts were not statistically different.


CONCLUSIONS
CUF and CUF+MUF were safe and efficient methods for patient stabilization independent of diagnosis and complexity of surgery. Future clinical evaluation should address a larger population of patients to research the different variables.
Maluf
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MA
Division of Cardiovascular Surgery, Universidade Federal de São Paulo, Rua Apeninos, 930 Conj 182, Paraiso, CEP 045104-020, São Paulo, Brazil. miguel@bes-way.com.br
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D000465:Algorithms; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012121:Respiration, Artificial; D012306:Risk; D016896:Treatment Outcome