HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thierry Carrel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berdat, P. A. Articles by Carrel, T. Search for Related Content PubMed PubMed Citation Articles by Berdat, P. A. Articles by Carrel, T. Related Collections Extracorporeal circulation

J Thorac Cardiovasc Surg 2004;127:1688-1696
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Elimination of proinflammatory cytokines in pediatric cardiac surgery: Analysis of ultrafiltration method and filter type

^a Clinic for Cardiovascular Surgery,University Hospital, Bern, Switzerland
^b Division of Pediatric Cardiology,University Hospital, Bern, Switzerland
^c Division of Cardiovascular Anesthesiology, University Hospital, Berne, Switzerland

Received for publication April 30, 2003; revisions received November 27, 2003; accepted for publication January 21, 2004.

^* Address for reprints: Pascal A. Berdat, MD, Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center Berne, University Hospital, CH-3010 Berne, Switzerland
pascal.berdat{at}insel.ch

OBJECTIVE: This study was undertaken to assess whether different filter types or ultrafiltration methods influence inflammatory markers in pediatric cardiac surgery.

METHODS: Forty-one children younger than 5 years were prospectively randomized to groups A (polyamid filter with conventional ultrafiltration), B (polyamid filter with modified ultrafiltration), C (polysulfon filter with conventional ultrafiltration), and D (polysulfon filter with modified ultrafiltration). Interleukin 6, interleukin 10, tumor necrosis factor, terminal complement complex, and lactoferrin were measured before the operation (T0), before rewarming (T1), after ultrafiltration (T2), at 6 (T3) and 18 hours (T4) after the operation, and in the ultrafiltrate.

RESULTS: All markers changed with both ultrafiltration methods, both filter types, and in all groups (except tumor necrosis factor) along the T0 to T4 observation time (P < .0001). Their patterns of changes were different for terminal complement complex, with less decrease after use of the polysulfon filter (P < .05), and among groups A through D for interleukin 6 (P = .01), with more decrease in group C than group A (P < .02). Interleukin 10 decreased with the polyamid filter (P < .001) but not with the polysulfon filter. In the ultrafiltrate, tumor necrosis factor was higher with the polysulfon filter than the polyamid filter (6.8 ± 5 pg/mL vs 4.0 ± 3.7 pg/mL, P < .05). The ultrafiltrate/plasma ratio of interleukin 6 was higher with conventional ultrafiltration than modified ultrafiltration (0.018 ± 0.017 vs 0.004 ± 0.007, P < .005).

CONCLUSIONS: The polysulfon filter showed a filtration profile for inflammatory mediators superior to that of the polyamid filter for interleukin 6, tumor necrosis factor, and interleukin 10. Interleukin 6 was most efficiently removed by conventional ultrafiltration with a polysulfon filter, and tumor necrosis factor was best removed by modified ultrafiltration with a polysulfon filter, whereas other inflammatory mediators were not influenced by filter type or ultrafiltration method. Therefore combined conventional and modified ultrafiltration with a polysulfon filter may currently be the most effective strategy for removing inflammatory mediators in pediatric heart surgery.

This article has been cited by other articles:

				Y. Banz, R. Rieben, C. Zobrist, P. Meier, S. Shaw, J. Lanz, T. Carrel, and P. Berdat Addition of dextran sulfate to blood cardioplegia attenuates reperfusion injury in a porcine model of cardiopulmonary bypass Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 653 - 660. [Abstract] [Full Text] [PDF]

				N. Yoshimura, Y. Oshima, M. Yoshida, H. Murakami, H. Matsuhisa, and M. Yamaguchi Continuous Hemodiafiltration During Cardiopulmonary Bypass in Infants Asian Cardiovasc Thorac Ann, October 1, 2007; 15(5): 376 - 380. [Abstract] [Full Text] [PDF]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				S. G Raja, S. Yousufuddin, F. Rasool, A. Nubi, M. Danton, and J. Pollock Impact of modified ultrafiltration on morbidity after pediatric cardiac surgery. Asian Cardiovasc Thorac Ann, August 1, 2006; 14(4): 341 - 350. [Abstract] [Full Text] [PDF]

				G. Brancaccio, E. Villa, E. Girolami, G. Michielon, C. Feltri, E. Mazzera, D. Costa, G. Isacchi, E. Iannace, A. Amodeo, et al. Inflammatory cytokines in pediatric cardiac surgery and variable effect of the hemofiltration process Perfusion, September 1, 2005; 20(5): 263 - 268. [Abstract] [PDF]