A prospective, randomized study of the effects of continuous ultrafiltration in hepatic patients after cardiac valve surgery.
OBJECTIVE
The use of continuous ultrafiltration may be effective in preventing the hepatic decompensation in cirrhotic patients after valvular heart surgery with cardiopulmonary bypass (CPB). The authors aimed to evaluate the effects of continuous ultrafiltration on the need for blood transfusion, liver function tests, duration of postoperative ventilatory support, and the length of the intensive care unit (ICU) stay in cirrhotic patients undergoing valvular heart surgery.


METHODS
A prospective, randomized double-blinded placebo study.


METHODS
A single university hospital.


METHODS
Sixty cirrhotic patients scheduled for valvular surgery.


METHODS
After local ethics committee approval and informed consent, participants were divided into 2 groups. In the conventional ultrafiltration (CUF) group (n = 30), CPB was used with conventional ultrafiltration. In the continuous ultrafiltration group (n = 30), in addition to the same CUF procedure, modified ultrafiltration was used after CPB.


RESULTS
Perioperative liver function tests, hematocrit, platelet count, the postoperative ventilation time, ICU and hospital length of stay, complications, and mortality were recorded. After CPB, patients receiving continuous ultrafiltration had a shorter time to extubation, postoperative ventilation time and ICU and hospital length of stay (p < 0.01), lower bleeding (p < 0.01), greater rise in hematocrit (11.3% +/- 2.39% v 4.7% +/- 1.22%, p = 0.001) and platelet count (7.0 +/- 3.0 v 0.8 +/- 0.21 10(4)/micromL, p = 0.001), higher albumin levels (p < 0.001), and lower plasma levels of bilirubin, aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase (p < 0.02). There was no significant difference between the 2 groups in the dosage of nitroglycerin or epinephrine, morbidity, or mortality.


CONCLUSIONS
The authors concluded that continuous ultrafiltration reduced postoperative bleeding and blood transfusions, improved liver function, and shortened the hospital stay in cirrhotic patients after valvular heart surgery.
Department of Anesthesia and Surgical ICU, King Faisal University, Dammam, Kingdom of Saudi Arabia. mohamedrefaateltahan@yahoo.com
Mohamed R
MR
El-Tahan
Reda A
RA
Hamad
Yasser F
YF
Ghoneimy
Mohamed I
MI
El Shehawi
Mohamed A
MA
Shafi
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011517:Prothrombin Time; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods*; D055815:Young Adult