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Conventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart
1Division 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
Insights
Conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) are safe for pediatric cardiac surgery. Both techniques effectively stabilize patients, with MUF showing greater fluid removal but no significant differences in clinical outcomes.
Area of Science:
- Cardiology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Cardiopulmonary bypass (CPB) in pediatric cardiac surgery can lead to fluid overload and inflammation.
- Conventional ultrafiltration (CUF) during CPB helps reduce excess body water.
- Modified ultrafiltration (MUF) after CPB may remove inflammatory mediators and improve hemodynamics.
Purpose of the Study:
- To critically assess the efficiency of CUF and MUF techniques in pediatric congenital heart disease surgeries.
- To compare the clinical outcomes of CUF versus CUF combined with MUF (CUF+MUF) in young patients undergoing CPB.
Main Methods:
- A prospective nonrandomized study involving 41 patients (9-36 months) undergoing cardiac defect correction with CPB.
- Patients were divided into two groups: CUF (ultrafiltration during CPB) and CUF+MUF (ultrafiltration during and after CPB).
- Outcomes compared included ventilator support, pediatric intensive care unit (PICU) stay, hospital stay, and transfusion requirements.
Main Results:
- The CUF+MUF group demonstrated significantly greater ultrafiltrate volume compared to the CUF group.
- No statistically significant differences were found between the groups in terms of ventilatory support, PICU stay, or hospital stay.
- Transfusion requirements, hematocrit, and platelet counts did not differ significantly between the CUF and CUF+MUF groups.
Conclusions:
- Both CUF and CUF+MUF are safe and effective methods for patient stabilization in congenital heart disease surgery.
- The choice of technique appears independent of surgical diagnosis or complexity.
- Further research with larger patient populations is recommended to explore various clinical variables.
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.