IMPACT OF ULTRAFILTRATION ON BLOOD USE FOR ATRIAL SEPTAL-DEFECT CLOSURE IN INFANTS AND CHILDREN

Background. Infants and children undergoing open cardiac operations ha ve a high incidence of blood product transfusion. Ultrafiltration has been shown to reverse hemodilution and improve myocardial function and hemodynamics after cardiopulmonary bypass (CPB). Methods. The effect of ultrafiltration on the amount of blood transfusion and hospital cha rge in 39 consecutive patients who underwent elective atrial septal de fect repair was examined. Patients in group I (n = 26) had a conventio nal cardiopulmonary circuit prime with blood, whereas 13 patients had bloodless prime (group II). Ultrafiltration was used immediately after weaning from CPB in group II. The patients in group I received blood products after discontinuation of CPB to achieve a hematocrit of 30%. The amount of blood product used, hematocrit immediately after CPB and on arrival in intensive tare unit, postoperative hemodynamics and sat urations, total operating room charge, blood charge, hospital stay, an d hospital charge were compared. Results. Mean body weight (15.8 kg in group I versus 17.5 kg in group II) and preoperative hematocrit value s (35.6% in group I versus 34.2% in group II) were similar. Mean hemat ocrit immediately after CPB was 22% and 14% in group I and II, respect ively (p < 0.0001). The mean hematocrit upon arrival to the intensive care unit was 34% in group I and 22% in group II (p < 0.0001). The amo unt of blood product transfusion was 32 mL/kg in group I and 3 mL/kg i n group II patients (p < 0.0001). The patients in group II had signifi cantly less blood bank charges; however, operating room charges and to tal hospital charges were similar between the two groups. Conclusions. Elective atrial septal defect repair was performed with no blood prod uct transfusion without increased morbidity or hospital stay. Ultrafil tration can be used to reverse hemodilution resulting from a bloodless CPB prime without an increase in hospital charge. (C) 1998 by The Soc iety of Thoracic Surgeons.