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High-Exchange Ultrafiltration to Enhance Recovery After Pediatric Cardiac Surgery: The ULTRA Randomized Controlled

Joel David Bierer1, Roger Stanzel2, Mark Henderson2

  • 1Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

The Annals of Thoracic Surgery
|January 29, 2026
PubMed

Insights

High-exchange ultrafiltration during pediatric cardiac surgery did not improve clinical outcomes or reduce inflammation compared to low-exchange methods. This study found no significant differences in key patient recovery markers between the two ultrafiltration strategies.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Critical Care
  • Inflammation Research

Background:

  • Pediatric cardiac surgery utilizing cardiopulmonary bypass (CPB) is frequently linked to systemic inflammation.
  • Investigating novel strategies to mitigate this inflammatory response is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the clinical immunomodulatory effect of continuous high-exchange ultrafiltration during CPB in pediatric patients.
  • To determine if high-exchange ultrafiltration impacts post-operative recovery and inflammatory markers.

Main Methods:

  • A single-center, double-blinded trial randomized pediatric patients (<15 kg) undergoing cardiac surgery to either high-exchange (H-SBUF, 60 ml/kg/hr) or low-exchange (L-SBUF, 6 ml/kg/hr) subzero-balance ultrafiltration during CPB.
  • The primary outcome was the peak post-operative vasoactive-ventilation-renal (VVR) score, with secondary outcomes including acute kidney injury, low cardiac output syndrome, and inflammatory mediator levels.

Main Results:

  • No significant difference was observed in the primary outcome (peak VVR score) between the H-SBUF and L-SBUF groups (p = 0.67).
  • Secondary clinical outcomes such as acute kidney injury, low cardiac output syndrome, ventilation time, inotrope use, and length of stay were similar between groups.
  • The H-SBUF group showed a higher fold change for IL-1α, P-selectin, and VCAM-1, but thirty-six other inflammatory mediators did not differ significantly.

Conclusions:

  • Continuous high-exchange subzero-balance ultrafiltration during CPB did not reduce peak VVR scores in pediatric cardiac surgery patients compared to low-exchange ultrafiltration.
  • No significant differences in secondary clinical outcomes or the overall immunologic profile were found between the high- and low-exchange ultrafiltration groups.
Abstract

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