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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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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