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Modified ultrafiltration reduces postoperative morbidity after cavopulmonary connection
T C Koutlas1, J W Gaynor, S C Nicolson
1Department of Anesthesiology, Children's Hospital of Philadelphia, PA 19104, USA.
Insights
Modified ultrafiltration significantly reduces complications in children undergoing staged cavopulmonary operations. This technique lowers blood use, effusions, and hospital stay, improving outcomes for single-ventricle anomaly repairs.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Cardiopulmonary bypass can cause adverse effects in children, particularly those with single-ventricle cardiac anomalies.
- Modified ultrafiltration is a technique to mitigate these adverse effects.
Purpose of the Study:
- To evaluate the effectiveness of modified ultrafiltration in reducing perioperative morbidity in children undergoing staged cavopulmonary operations.
- To assess the impact of modified ultrafiltration on postoperative outcomes in this patient population.
Main Methods:
- A retrospective review of 120 consecutive cavopulmonary operations performed between January 1995 and June 1996.
- Comparison of outcomes between 41 patients who underwent modified ultrafiltration and 79 control patients who did not.
- Procedures included Fontan variations and bidirectional Glenn shunts.
Main Results:
- Operative mortality was low at 0.8% (1 death).
- Patients receiving modified ultrafiltration showed significantly decreased postoperative blood use, chest tube output, pleural and pericardial effusions, and hospital stay.
- Key patient demographics and bypass times were similar between groups.
Conclusions:
- Modified ultrafiltration is a valuable adjunct in staged cavopulmonary operations for single-ventricle anomalies.
- The technique contributes to improved perioperative outcomes and reduced morbidity.
- This supports the use of modified ultrafiltration in pediatric cardiac surgery for complex congenital heart defects.
Background:
Modified ultrafiltration reduces the deleterious effects of cardiopulmonary bypass in children. Patients undergoing repair of single-ventricle cardiac anomalies may be particularly sensitive to these adverse effects, and benefit from the use of modified ultrafiltration.
Methods:
From January 1995 to June 1996, 120 consecutive cavopulmonary operations were performed at The Children's Hospital of Philadelphia. Procedures included lateral tunnel fenestrated Fontan (n = 50), extracardiac Fontan (n = 5), hemi-Fontan (n = 60), and bidirectional Glenn shunt (n = 5). Modified ultrafiltration was performed after cardiopulmonary bypass in 41 patients, and results were compared by t test with a control group of 79 patients in whom modified ultrafiltration was not used.
Results:
There was one death for an operative (30-day) mortality of 0.8%. Age, weight, diagnosis, ischemic arrest time, and cardiopulmonary bypass time were similar between the modified ultrafiltration and control groups. Postoperative blood use, chest tube output, the incidence of pleural and pericardial effusions, and hospital stay were all significantly decreased when modified ultrafiltration was used.
Conclusions:
By lowering the perioperative morbidity of staged cavopulmonary operations, modified ultrafiltration makes an important contribution to improving outcome after the correction of single-ventricle cardiac anomalies.