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The Journal of Cardiovascular Surgery 2001 August;42(4):465-73

language: English

Conventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart disease

Maluf M. A., Mangia C., Silva C., Carvalho W. B., Carvalho A. C., Buffolo E.

From ­the Division of Cardiovascular Surgery Universidade Federal de São Paulo São Paulo, SP, Brazil


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Background. This pros­pec­tive non­ran­dom­ized ­study is ­the crit­i­cal assess­ment of con­ven­tion­al ultra­fil­tra­tion (­CUF) ­and mod­i­fied ultra­fil­tra­tion (­MUF) tech­niques ­and ­their effi­cien­cy in con­gen­i­tal ­heart dis­ease sur­ger­ies. Use of car­di­o­pul­mo­nary ­bypass (­CPB) in chil­dren is asso­ciat­ed ­with ­body ­water reten­tion as a con­se­quence of ­prime vol­ume ­and system­ic inflam­ma­to­ry reac­tion. The ­CUF dur­ing ­CPB ­has ­reduced ­body ­water ­excess ­and ­the ­MUF ­after ­CPB, ­removes inflam­ma­to­ry medi­a­tors, ­improves hemo­dy­nam­ic per­for­mance, ­and decreas­es trans­fu­sion require­ments.
Methods. Forty-­one ­patients, ­aged 9 to 36 ­months, sub­mit­ted to sur­gi­cal cor­rec­tion ­for car­diac ­defects, ­using ­CPB, ­were divid­ed ­into 2 sim­i­lar ­groups: ­CUF (21 ­patients) oper­at­ed ­between 1996-1997 ­were ultra­fil­tered dur­ing ­CPB, ­and ­CUF+­MUF, (20 ­patients) oper­at­ed ­between 1997-1998 ­and ultra­fil­tered dur­ing ­and ­after ­CPB. Postoperative dura­tion of ven­ti­la­tor sup­port, pedi­at­ric inten­sive ­care ­unit ­stay (­PICU), hos­pi­tal ­stay of ­the ­groups ­with ­and with­out pre­op­er­a­tive pul­mo­nary hyper­ten­sion (PH), as ­well as trans­fu­sion require­ment, hem­a­toc­rit ­and plate­let ­counts ­were com­pared.
Results. There ­were no tech­ni­cal com­pli­ca­tions ­and a sig­nif­i­cant ultra­fil­trate in ­the ­CUF+­MUF ­group ­was ­observed as com­pared to ­the ­CUF ­group. No sig­nif­i­cant dif­fer­enc­es ­were ­observed ­between ­the ­CUF ­and ­CUF+­MUF ­groups regard­ing ven­til­a­to­ry sup­port, ­PICU ­stay ­and hos­pi­tal ­stay. Requirements ­for ­red ­cell trans­fu­sion, Ht ­and plate­let ­counts ­were ­not sta­tis­ti­cal­ly dif­fer­ent.
Conclusions. ­CUF ­and ­CUF+­MUF ­were ­safe ­and effi­cient meth­ods ­for ­patient sta­bil­iza­tion inde­pen­dent of diag­no­sis ­and com­plex­ity of sur­gery. Future clin­i­cal eval­u­a­tion ­should ­address a larg­er pop­u­la­tion of ­patients to ­research ­the dif­fer­ent var­i­ables.

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