MODIFIED ULTRAFILTRATION REDUCES POSTOPERATIVE MORBIDITY AFTER CAVOPULMONARY CONNECTION

Background. Modified ultrafiltration reduces the deleterious effects o f cardiopulmonary bypass in children. Patients undergoing repair of si ngle-ventricle cardiac anomalies may be particularly sensitive to thes e adverse effects, and benefit from the use of modified ultrafiltratio n. Methods. From January 1995 to June 1996, 120 consecutive cavopulmon ary operations were performed at The Children's Hospital of Philadelph ia. Procedures included lateral tunnel fenestrated Fontan (n = 50), ex tracardiac Fontan (n = 5), hemi-Fontan (n = 60), and bidirectional Gle nn shunt (n = 5). Modified ultrafiltration was performed after cardiop ulmonary bypass in 41 patients, and results were compared by t test wi th a control group of 79 patients in Whom modified ultrafiltration was not used. Results. There was one death for an operative (30-day) mort ality of 0.8%. Age, weight, diagnosis, ischemic arrest time, and cardi opulmonary bypass time were similar between the modified ultrafiltrati on and control groups. Postoperative blood use, chest tube output, the incidence of pleural and pericardial effusions, and hospital stay wer e all significantly decreased when modified ultrafiltration was used. Conclusions. By lowering the perioperative morbidity of staged cavopul monary operations, modified ultrafiltration makes an important contrib ution to improving outcome after the correction of single-ventricle ca rdiac anomalies. (C) 1997 by The Society of Thoracic Surgeons.