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Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement
K Saatvedt1, H Lindberg, O R Geiran
1Department of Cardiovascular Surgery, Rikshospitalet, University of Oslo, Norway.
Insights
Intraoperative extracorporeal ultrafiltration (UF) did not show clinical or hemodynamic benefits in children undergoing open heart surgery. This technique also failed to reduce plasma concentrations of cytokines or complement activation products.
Area of Science:
- Pediatric cardiac surgery
- Cardiopulmonary bypass complications
- Inflammatory response modulation
Background:
- Open heart surgery in children can trigger significant inflammatory responses.
- Cytokines and complement activation products are key mediators of this response.
- Understanding methods to mitigate this inflammation is crucial for patient outcomes.
Purpose of the Study:
- To assess the clinical and hemodynamic impact of intraoperative extracorporeal ultrafiltration (UF).
- To determine if UF can reduce plasma levels of circulating cytokines and complement activation products after pediatric open heart surgery.
Main Methods:
- Prospective randomized study of 18 children with congenital heart disease undergoing open heart surgery.
- Comparison between a control group and a group undergoing UF during cardiopulmonary bypass (CPB).
- Serial plasma sampling for cytokine (IL-6, TNF, sTNF receptor) and complement (C3a, C3bc, TCC) measurements; hemodynamic monitoring via pulmonary artery catheter.
Main Results:
- No significant differences in postoperative hemodynamics between UF and control groups.
- Perioperative increases in IL-6, sTNF receptors, C3a, C3bc, and TCC were observed in both groups.
- UF did not significantly reduce plasma levels of measured cytokines or complement activation products postoperatively; TNF and C3a were occasionally detected in ultrafiltrate.
Conclusions:
- Intraoperative extracorporeal UF provided no demonstrable clinical or hemodynamic benefit in this pediatric cohort.
- The study failed to show a reduction in key inflammatory markers (cytokines, complement products) using UF.
- Further research may be needed to explore alternative or modified ultrafiltration strategies.
Objectives:
The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children.
Methods:
Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring.
Results:
Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively.
Conclusions:
In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.