ULTRAFILTRATION AFTER CARDIOPULMONARY BYPASS IN CHILDREN - EFFECTS ONHEMODYNAMICS, CYTOKINES AND COMPLEMENT

Objective: The purpose of the study was to evaluate the clinical and h emodynamic effect of intraoperative extracorporeal ultrafiltration (UF ) and its potential in reducing the plasma concentration of circulatin g cytokines and complement activation products following open heart su rgery in children. Methods: Eighteen children with congenital heart di sease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurement s of circulating cytokines (interleukin 6 (IL-6), tumor necrosis facto r alpha (TNF), and its soluble receptor (sTNF receptor)), and compleme nt factors (C3 activation products (C3a and C3bc) and terminal complem ent complex (TCC)) were obtained before, during and up to 48 h after c ardiopulmonary bypass (CPB). A pulmonary artery thermodilution cathete r was introduced preoperatively for hemodynamic monitoring. Results: P ostoperative hemodynamics were similar in both groups. Plasma levels o f IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly peri operatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples i n concentrations similar to the plasma levels. Complement activating p roducts were not detected in the ultrafiltration samples except for sm all amounts of C3a in two cases. Compared to the control group the pla sma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significant ly after 15 min of UF but there was no significant difference between the two groups postoperatively. Conclusions: In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occas ionally detected in the ultrafiltrate but we were unable to demonstrat e reduction of these or any of the other markers tested in the group s ubjected to ultrafiltration.