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Use of the modified technique of ultrafiltration in pediatric open-heart surgery: a prospective study
1Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva, Israel.
Insights
Modified ultrafiltration (MUF) during cardiopulmonary bypass in children significantly improves hemodynamic status and reduces the need for blood transfusions. This technique offers better outcomes for pediatric cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Extracorporeal Circulation
Background:
- Cardiopulmonary bypass (CPB) in pediatric patients often leads to fluid overload and associated morbidity.
- Conventional methods like diuresis, peritoneal dialysis, and conventional ultrafiltration (CUF) have limitations in managing fluid balance during CPB.
- Previous ultrafiltration techniques were found to be insufficient for improving outcomes in young cardiac surgery patients.
Purpose of the Study:
- To evaluate the efficacy of a modified ultrafiltration (MUF) technique in pediatric patients undergoing CPB.
- To compare the outcomes of MUF with conventional methods in terms of fluid management and patient status.
- To assess the impact of MUF on hemodynamic parameters, blood loss, and transfusion requirements.
Main Methods:
- Eighty pediatric patients were prospectively studied and divided into two groups: MUF (Group A) and control (Group B).
- MUF was performed for 15 minutes post-CPB, targeting a hematocrit of 40%.
- Hemodynamic status, cardiac size, hematocrit levels, blood loss, and transfusion requirements were monitored and compared between groups.
Main Results:
- The MUF group showed smaller cardiac size, improved cardiac performance, and higher systemic blood pressure post-procedure.
- Post-CPB hematocrit was significantly higher in the MUF group (39.4% vs. 28.5%, P <0.05).
- The MUF group experienced significantly less blood loss (10.56 ml/kg/24h vs. 20.8 ml/kg/24h, P <0.05) and required fewer blood and colloid transfusions.
Conclusions:
- Modified ultrafiltration (MUF) leads to better hemodynamic status in pediatric patients following cardiopulmonary bypass.
- MUF offers the advantages of reduced blood loss and decreased transfusion needs compared to conventional methods.
- Combining MUF with established surgical techniques holds promise for improving outcomes in complex pediatric cardiac malformations.
Abstract:
The use of cardiopulmonary bypass (CPB) in children is associated with significant morbidity due to the accumulation of an excessive amount of water. This can be decreased by massive diuresis, peritoneal dialysis, or conventional ultrafiltration technique (CUF) during bypass. However, we were dissatisfied with their effect on the outcome of our young patients, and recently began to use the modified technique of ultrafiltration (MUF) with good results. MUF was carried out for 15 min after completion of CPB to a hematocrit of 40%. Eighty patients were equally divided into two groups--MUF (group A) and control (group B)--and prospectively studied. There was one death in group A and two deaths in group B. The chest was left open in one patient in group A and in three patients in group B. At the end of MUF, the cardiac size was smaller, performance was better, and systemic blood pressure was higher in group A. Hematocrit levels in the two groups were similar during preoperative and CPB time, but post-CPB hematocrit in group A was significantly higher, 39.4% mean (range 35-50) vs. 28.5 (range 22-38) in group B (P <0.05). Blood loss was 10.56 ml/kg per 24 h (2-48.7) in group A vs. 20.8 (4.5-105.6) in group B (P <0.05). Blood transfused was 7.2 ml/kg per 24 h (0-29) in group A vs. 17.3 (3.1-49) in group B (P <0.05). Colloids transfused were 16.7 ml/kg per 24 h (0-64) in group A vs. 27.5 (0-58.6) in group B (P <0.05). No significant difference was found in urine output or the use of diuretics between the two groups. MUF results in better hemodynamic status in children, with the added advantage of less transfused blood and blood products. We believe that the use of accepted surgical techniques in combination with MUF will further improve the outcome of complex cardiac malformations.