Clinical efficacy of peritoneovenous shunting for the treatment of severe ovarian hyperstimulation syndrome

We investigated prospectively the clinical efficacy of a newly developed co ntinuous autotransfusion system of ascites (CATSA) without protein suppleme nt in patients with severe ovarian hyperstimulation syndrome (OHSS). Perito neovenous shunting was used to recirculate ascites, The CATSA was performed for 5 h at a rate of 100-200 ml/h once a day. Eighteen patients were treat ed with the CATSA (CATSA group) and 36 were treated with an intravenous 37. 5 g/day of albumin supplement (albumin group). Hospital stay was significan tly shorter in the CATSA group than in the albumin group (10.0 +/- 5.7 vers us 13.9 +/- 6.2 days, P < 0.01). Haematocrit value reached <40% significant ly earlier in the CATSA group (on hospital days 3.9 +/- 3.2 versus 5.9 +/- 2.5, P < 0.01). Using a single procedure, haemoconcentration, urinary outpu t and pulse pressure were markedly improved in the CATSA group compared wit h the albumin group. Discomfort due to massive ascites diminished promptly and did not recur in nine of 18 CATSA group patients, whereas it persisted in all 36 patients in the albumin group. The serum concentration of protein was maintained in the CATSA group, whereas it did not increase in the albu min group despite daily supplementation with 37.5 g of albumin. Apparent ad verse effects of each procedure were not observed in either group. The mean values of several parameters in the serum pertinent to the coagulation-fib rinolysis system did not change significantly in either group after the pro cedure. It was concluded that the CATSA procedure expanded circulating plas ma volume without exogenous albumin and appeared to lead to a prompt recove ry from severe conditions of OHSS.