Modified ultrafiltration reduces morbidity after adult cardiac operations - A prospective, randomized clinical trial

Background-Extracorporeal circulation contributes to morbidity after open-h eart surgery by causing a systemic inflammatory reaction. Modified ultrafil tration is a technique able to remove the fluid overload and inflammatory m ediators associated with use of cardiopulmonary bypass. It has been shown t o reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. Methods and Results-Five hundred seventy-three consecutive adult patients w ere prospectively randomized to either ultrafiltration after cardiopulmonar y bypass (treatment) or to no ultrafiltration (control). Parsonnet score wa s used to assess the severity of the patients' clinical conditions. Analysi s was done with Student's t test or Mann-Whitney U test for continuous vari ables and Fisher's exact test or Pearson's chi (2) for discrete variables. Hospital mortality was 2.5% (7 of 284) in the treatment group versus 3.8% ( 11 of 289) in the control group (P=0.357). Hospital morbidity was lower in treated patients (66 of 284 [23.2%] versus 117 of 289 [40.5%], P= 0.0001). Cardiac morbidity was similar (26 of 284 [9.1%] versus 35 of 289 [12.1%], P =0.251), whereas significantly lower rates of respiratory (20 of 284 [7.0%] versus 36 of 289 [12.5%], P=0.029), neurological (5 of 284 [1.8%] versus 1 4 of 289 [4.8%]. P=0.039), and gastrointestinal (0 of 284 versus 4 of 289 [ 1.4%], P=0.044) complications were found in treated patients. Transfusion r equirements were also lower in treated patients (1.66 +/-2.6 versus 2.25 +/ -3.8 U/patient, P=0.039). Duration of intensive care (39.9 +/- 49.2 versus 46.3 +/- 72.8 hours, P=0.218) and hospital stay (7.6 +/-3.5 versus 7.9 +/-4 .4 days, P=0.372) were comparable. Conclusions-Modified ultrafiltration after cardiopulmonary bypass is associ ated with a lower prevalence of early morbidity and lower blood transfusion requirements. The impact on length of hospital stay needs further analysis . Routine application of modified ultrafiltration after adult cardiac opera tions is warranted.