Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease

Ko Bando, Mark Turrentine, Palaniswamy Vijay, Thomas G. Sharp, Yasuo Sekine, Brian J. Lalone, Laszlo Szekely, John Brown

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Abstract

Background. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease. Methods. Informed consent was obtained from 100 consecutive patients with complex congenital heart disease undergoing operations with CPB. They were randomized into a control group (n = 50) of conventional ultra filtration during bypass and an experimental group using dilutional ultrafiltration during bypass and venovenous modified ultrafiltration after bypass (MUF group, n = 50). Postoperative arterial oxygenation, duration of ventilatory support, transfusion requirements, hematocrit, chest tube output, and time to chest tube removal were compared between the groups stratified by age and weight, CPB technique, existence of preoperative pulmonary hypertension, and diagnosis. Results. There were no MUF-related complications. In patients with preoperative pulmonary hypertension, MUF significantly improved postoperative oxygenation (445 ± 129 mm Hg versus control: 307 ± 113 mm Hg, p = 0.002), shortened ventilatory support (42.9 ± 29.5 hours versus control: 162.4 ± 131.2 hours, p = 0.0005), decreased blood transfusion (red blood cells: 16.2 ± 18.2 mL/kg versus control: 41.4 ± 27.8 mL/kg, p = 0.01; coagulation factors: 5.3. ± 6.9 mL/kg versus control: 32.3 ± 15.5 mL/kg, p = 0.01), and led to earlier chest tube removal. In neonates (≤30 days), MUF significantly reduced transfusion of coagulation factors (5.4 ± 5.0 mL/kg versus control: 39.9 ± 25.8 mL/kg, p = 0.007), and duration of ventilatory support (59.3 ± 36.2 hours versus 242.1 ± 143.1 hours, p = 0.0009). In patients with prolonged CPB (>120 minutes), MUF significantly reduced the duration of ventilatory support (44.7 ± 37.0 hours versus 128.7 ± 133.4 hours, p = 0.002). No significant differences were observed between MUF and control patients for any parameter in the presence of ventricular septal defect without pulmonary hypertension, tetralogy of Fallot, or aortic stenosis. Conclusions. Modified ultrafiltration after CPB is safe and decreases the need for homologous blood transfusion, the duration of ventilatory support, and chest tube placement in selected patients with complex congenital heart disease. The optimal use of MUF includes patients with preoperative pulmonary hypertension, neonates, and patients who require prolonged CPB.

Original languageEnglish
Pages (from-to)821-828
Number of pages8
JournalAnnals of Thoracic Surgery
Volume66
Issue number3
DOIs
StatePublished - Sep 1998

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Ultrafiltration
Heart Diseases
Cardiopulmonary Bypass
Chest Tubes
Pulmonary Hypertension
Blood Coagulation Factors
Blood Transfusion
Newborn Infant
Tetralogy of Fallot
Body Water
Health Services Needs and Demand
Ventricular Heart Septal Defects
Aortic Valve Stenosis
Informed Consent
Hematocrit
Age Groups
Erythrocytes
Hemodynamics
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease. / Bando, Ko; Turrentine, Mark; Vijay, Palaniswamy; Sharp, Thomas G.; Sekine, Yasuo; Lalone, Brian J.; Szekely, Laszlo; Brown, John.

In: Annals of Thoracic Surgery, Vol. 66, No. 3, 09.1998, p. 821-828.

Research output: Contribution to journalArticle

Bando, Ko ; Turrentine, Mark ; Vijay, Palaniswamy ; Sharp, Thomas G. ; Sekine, Yasuo ; Lalone, Brian J. ; Szekely, Laszlo ; Brown, John. / Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease. In: Annals of Thoracic Surgery. 1998 ; Vol. 66, No. 3. pp. 821-828.
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title = "Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease",
abstract = "Background. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease. Methods. Informed consent was obtained from 100 consecutive patients with complex congenital heart disease undergoing operations with CPB. They were randomized into a control group (n = 50) of conventional ultra filtration during bypass and an experimental group using dilutional ultrafiltration during bypass and venovenous modified ultrafiltration after bypass (MUF group, n = 50). Postoperative arterial oxygenation, duration of ventilatory support, transfusion requirements, hematocrit, chest tube output, and time to chest tube removal were compared between the groups stratified by age and weight, CPB technique, existence of preoperative pulmonary hypertension, and diagnosis. Results. There were no MUF-related complications. In patients with preoperative pulmonary hypertension, MUF significantly improved postoperative oxygenation (445 ± 129 mm Hg versus control: 307 ± 113 mm Hg, p = 0.002), shortened ventilatory support (42.9 ± 29.5 hours versus control: 162.4 ± 131.2 hours, p = 0.0005), decreased blood transfusion (red blood cells: 16.2 ± 18.2 mL/kg versus control: 41.4 ± 27.8 mL/kg, p = 0.01; coagulation factors: 5.3. ± 6.9 mL/kg versus control: 32.3 ± 15.5 mL/kg, p = 0.01), and led to earlier chest tube removal. In neonates (≤30 days), MUF significantly reduced transfusion of coagulation factors (5.4 ± 5.0 mL/kg versus control: 39.9 ± 25.8 mL/kg, p = 0.007), and duration of ventilatory support (59.3 ± 36.2 hours versus 242.1 ± 143.1 hours, p = 0.0009). In patients with prolonged CPB (>120 minutes), MUF significantly reduced the duration of ventilatory support (44.7 ± 37.0 hours versus 128.7 ± 133.4 hours, p = 0.002). No significant differences were observed between MUF and control patients for any parameter in the presence of ventricular septal defect without pulmonary hypertension, tetralogy of Fallot, or aortic stenosis. Conclusions. Modified ultrafiltration after CPB is safe and decreases the need for homologous blood transfusion, the duration of ventilatory support, and chest tube placement in selected patients with complex congenital heart disease. The optimal use of MUF includes patients with preoperative pulmonary hypertension, neonates, and patients who require prolonged CPB.",
author = "Ko Bando and Mark Turrentine and Palaniswamy Vijay and Sharp, {Thomas G.} and Yasuo Sekine and Lalone, {Brian J.} and Laszlo Szekely and John Brown",
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T1 - Effect of modified ultrafiltration in high-risk patients undergoing operations for congenital heart disease

AU - Bando, Ko

AU - Turrentine, Mark

AU - Vijay, Palaniswamy

AU - Sharp, Thomas G.

AU - Sekine, Yasuo

AU - Lalone, Brian J.

AU - Szekely, Laszlo

AU - Brown, John

PY - 1998/9

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N2 - Background. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease. Methods. Informed consent was obtained from 100 consecutive patients with complex congenital heart disease undergoing operations with CPB. They were randomized into a control group (n = 50) of conventional ultra filtration during bypass and an experimental group using dilutional ultrafiltration during bypass and venovenous modified ultrafiltration after bypass (MUF group, n = 50). Postoperative arterial oxygenation, duration of ventilatory support, transfusion requirements, hematocrit, chest tube output, and time to chest tube removal were compared between the groups stratified by age and weight, CPB technique, existence of preoperative pulmonary hypertension, and diagnosis. Results. There were no MUF-related complications. In patients with preoperative pulmonary hypertension, MUF significantly improved postoperative oxygenation (445 ± 129 mm Hg versus control: 307 ± 113 mm Hg, p = 0.002), shortened ventilatory support (42.9 ± 29.5 hours versus control: 162.4 ± 131.2 hours, p = 0.0005), decreased blood transfusion (red blood cells: 16.2 ± 18.2 mL/kg versus control: 41.4 ± 27.8 mL/kg, p = 0.01; coagulation factors: 5.3. ± 6.9 mL/kg versus control: 32.3 ± 15.5 mL/kg, p = 0.01), and led to earlier chest tube removal. In neonates (≤30 days), MUF significantly reduced transfusion of coagulation factors (5.4 ± 5.0 mL/kg versus control: 39.9 ± 25.8 mL/kg, p = 0.007), and duration of ventilatory support (59.3 ± 36.2 hours versus 242.1 ± 143.1 hours, p = 0.0009). In patients with prolonged CPB (>120 minutes), MUF significantly reduced the duration of ventilatory support (44.7 ± 37.0 hours versus 128.7 ± 133.4 hours, p = 0.002). No significant differences were observed between MUF and control patients for any parameter in the presence of ventricular septal defect without pulmonary hypertension, tetralogy of Fallot, or aortic stenosis. Conclusions. Modified ultrafiltration after CPB is safe and decreases the need for homologous blood transfusion, the duration of ventilatory support, and chest tube placement in selected patients with complex congenital heart disease. The optimal use of MUF includes patients with preoperative pulmonary hypertension, neonates, and patients who require prolonged CPB.

AB - Background. Modified ultrafiltration (MUF) after cardiopulmonary bypass (CPB) in children decreases body water, removes inflammatory mediators, improves hemodynamics, and decreases transfusion requirements. The optimal target population for MUF needs to be defined. This prospective, randomized study attempted to identify the best candidates for MUF during operations for congenital heart disease. Methods. Informed consent was obtained from 100 consecutive patients with complex congenital heart disease undergoing operations with CPB. They were randomized into a control group (n = 50) of conventional ultra filtration during bypass and an experimental group using dilutional ultrafiltration during bypass and venovenous modified ultrafiltration after bypass (MUF group, n = 50). Postoperative arterial oxygenation, duration of ventilatory support, transfusion requirements, hematocrit, chest tube output, and time to chest tube removal were compared between the groups stratified by age and weight, CPB technique, existence of preoperative pulmonary hypertension, and diagnosis. Results. There were no MUF-related complications. In patients with preoperative pulmonary hypertension, MUF significantly improved postoperative oxygenation (445 ± 129 mm Hg versus control: 307 ± 113 mm Hg, p = 0.002), shortened ventilatory support (42.9 ± 29.5 hours versus control: 162.4 ± 131.2 hours, p = 0.0005), decreased blood transfusion (red blood cells: 16.2 ± 18.2 mL/kg versus control: 41.4 ± 27.8 mL/kg, p = 0.01; coagulation factors: 5.3. ± 6.9 mL/kg versus control: 32.3 ± 15.5 mL/kg, p = 0.01), and led to earlier chest tube removal. In neonates (≤30 days), MUF significantly reduced transfusion of coagulation factors (5.4 ± 5.0 mL/kg versus control: 39.9 ± 25.8 mL/kg, p = 0.007), and duration of ventilatory support (59.3 ± 36.2 hours versus 242.1 ± 143.1 hours, p = 0.0009). In patients with prolonged CPB (>120 minutes), MUF significantly reduced the duration of ventilatory support (44.7 ± 37.0 hours versus 128.7 ± 133.4 hours, p = 0.002). No significant differences were observed between MUF and control patients for any parameter in the presence of ventricular septal defect without pulmonary hypertension, tetralogy of Fallot, or aortic stenosis. Conclusions. Modified ultrafiltration after CPB is safe and decreases the need for homologous blood transfusion, the duration of ventilatory support, and chest tube placement in selected patients with complex congenital heart disease. The optimal use of MUF includes patients with preoperative pulmonary hypertension, neonates, and patients who require prolonged CPB.

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