Conventional and conventional plus modified ultrafiltration during cardiacsurgery in high-risk congenital heart disease

Background. This prospective nonrandomized study is the critical assessment of conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) t echniques and their efficiency in congenital heart disease surgeries. Use o f cardiopulmonary bypass (C PB) in children is associated with body water r etention as a consequence of prime volume and systemic inflammatory reactio n. The CUF during CPB has reduced body water excess and the MUF after CPB, removes inflammatory mediators, improves hemodynamic performance, and decre ases transfusion requirements. Methods. Forty-one patients, aged 9 to 36 months, submitted to surgical cor rection for cardiac defects, Using CPB, were divided into 2 similar groups: CUF (21 patients) operated between 1996-1997 were ultrafiltered during CPB , and CUF+MUF, (20 patients) operated between 1997-1998 and ultrafiltered d uring and after CPB. Postoperative duration of ventilator support, pediatri c intensive care unit stay (PICU), hospital stay of the groups with and wit hout preoperative pulmonary hypertension (PH), as well as transfusion requi rement, hematocrit and platelet counts were compared. Results. There were no technical complications and a significant ultrafiltr ate in the CUF+MUF group was observed as compared to the CUF group. No sign ificant differences were observed between the CUF and CUF+MUF groups regard ing ventilatory support, PICU stay and hospital stay. Requirements for red cell transfusion, Ht and platelet counts were not statistically different. Conclusions. CUF and CUF+MUF were safe and efficient methods for patient st abilization independent of diagnosis and complexity of surgery. Future clin ical evaluation should address a larger population of patients to research the different variables.