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Published on: November 28, 2018
Effect of veno-venous ultrafiltration on myocardial performance immediately after cardiac surgery in children. A
E S Rivera1, T R Kimball, W W Bailey
1Division of Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Insights
Veno-venous ultrafiltration (UF) significantly improved myocardial contractility in children after cardiopulmonary bypass (CPB) for congenital heart defect repair. This suggests UF enhances cardiac function and potentially reduces myocardial edema, improving patient outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Ultrafiltration (UF) is used post-cardiopulmonary bypass (CPB) to manage fluid overload in pediatric cardiac surgery patients.
- The precise mechanism by which UF impacts hemodynamics remains unclear.
- Previous studies suggest UF improves immediate post-CPB hemodynamics.
Purpose of the Study:
- To assess the impact of veno-venous ultrafiltration (UF) on myocardial contractility in pediatric patients undergoing CPB.
- To investigate potential mechanisms linking UF to improved hemodynamic function in this population.
Main Methods:
- Twenty-three pediatric patients (2 months–9.1 years) undergoing CPB for congenital heart defect repair were studied.
- Veno-venous ultrafiltration (UF) was administered for 10 minutes post-CPB.
- Myocardial contractility was assessed using transesophageal echocardiography to measure the velocity of circumferential fiber shortening relative to wall stress; left ventricular wall thickness was also measured.
Main Results:
- Significant improvement in myocardial contractility was observed after UF in both study groups (p < 0.05).
- The ratio of myocardial thickness to left ventricular cavity dimension decreased post-UF in both groups (p < 0.05).
- These findings indicate UF enhances cardiac function and reduces myocardial edema.
Conclusions:
- Veno-venous ultrafiltration (UF) positively impacts myocardial contractility in pediatric cardiac surgery patients.
- UF may improve hemodynamic status by reducing myocardial edema and enhancing contractility.
- These UF-induced changes may contribute to improved patient outcomes following cardiac surgery.
Objectives:
This study sought to evaluate the effects of veno-venous ultrafiltration on myocardial contractility in children undergoing cardiopulmonary bypass (CPB) for repair of congenital heart defects.
Background:
Ultrafiltration (UF) is currently used to diminish postoperative fluid accumulation following CPB in children. Previous reports indicate improvement in hemodynamics immediately after UF, but the mechanism of its action is unknown.
Methods:
Twenty-three patients (ages 2 months to 9.1 years; 13 males, 10 females) underwent UF for 10 min after CPB. Twelve patients underwent UF immediately after CPB (Group A). They were studied: (1) before and (2) after CPB, (3) after UF, and (4) 10 min after UF. Eleven patients underwent UF 10 min after CPB (Group B). They were studied: (1) before and (2) after CPB, (3) after a 10-min delay before UF, and (4) after UF. Contractility was determined by the difference in the observed and predicted velocity of circumferential fiber shortening for the measured wall stress, using transesophageal echocardiography. Left ventricular wall thickness was also measured.
Results:
There was significant improvement in contractility after UF in both groups (mean+/-SD, Group A: -0.28+/-0.13 to -0.01+/-0.21 circ/s, p < 0.05; Group B: -0.26+/-0.16 to -0.11+/-0.17 circ/s, p < 0.05). Myocardial thickness to cavity dimension decreased in both groups following UF (Group A: 0.19+/-0.04 to 0.14+/-0.03, p < 0.05; Group B: 0.18+/-0.04 to 0.14+/-0.03, p < 0.05).
Conclusions:
UF improves hemodynamics by improving contractility and possibly by reducing myocardial edema in children following cardiac surgery. Enhanced patient outcome after ultrafiltration may in part be due to these changes.
