Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass

To evaluate the effects of hemofiltration performed during rewarming before emergence from cardiopulmonary bypass on hemodynamic and echocardiographic parameters.

Prospective randomized study; blind analysis of echocardiographic parameters and hemodynamic parameters.

Single-center study performed in a university hospital.

Two groups of 13 adult patients undergoing coronary artery bypass graft surgery.

Patients were randomized to conventional procedure or hemofiltration performed with a polysulfone hemofilter. Hemofiltration, started at the time of rewarming on cardiopulmonary bypass, was performed with a flow rate adjusted to achieve an ultrafiltrate volume of 15 mL/kg on completion of rewarming.

Hemodynamic (systemic mean arterial pressure, right atrial pressure, heart rate) and echocardiographic parameters (shortening fraction, segmental kinetic score, cardiac output, systemic vascular resistance) were measured before and after hemofiltration and on arrival in the intensive care unit. Heart rate and cardiac index were increased significantly in both groups during the postoperative period. In the control group, systemic vascular resistance was decreased significantly, and cardiac index was increased during the postoperative period, together with significant alterations of segmental kinetic score and shortening fraction. In the hemofiltration group, systemic vascular resistance remained unchanged, associated with a significantly improved segmental kinetic score compared with the control group.

Hemofiltration performed during rewarming before emergence from cardiopulmonary bypass is associated with stability of hemodynamic parameters and improved segmental myocardial kinetics.