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J Thorac Cardiovasc Surg 2006;132:1291-1298
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Modified and conventional ultrafiltration during pediatric cardiac surgery: Clinical outcomes compared

Glyn D. Williams, MBa,b,*, Chandra Ramamoorthy, MDa,b, Larry Chu, MD, MSa, Gregory B. Hammer, MDa,b, Komal Kamra, MBa,b, Madalane G. Boltz, MDa,b, Krassimira Pentchevaa, James P. McCarthy, CCPa, Vadiyala M. Reddy, MDa,b

a Stanford University School of Medicine, Stanford, Calif
b Lucile Packard Children’s Hospital, Stanford, Calif.

Received for publication February 8, 2006; revisions received May 3, 2006; accepted for publication May 12, 2006.

* Address for reprints: Glyn David Williams, MB, Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Dr, H3587, Stanford, CA 94305-5640 (Email: jumbo{at}stanford.edu).

OBJECTIVE: This prospective study compared clinical outcomes after heart surgery between three groups of infants with congenital heart disease. One group received dilutional conventional ultrafiltration (group D), another received modified ultrafiltration (group M), and a third group received both dilutional conventional and modified ultrafiltration (group B). We hypothesized that group B patients would have the best clinical outcome.

METHODS: Children younger than 1 year undergoing heart surgery for biventricular repair by the same surgeon were randomly allocated to one of the three study groups. Patient management was standardized, and intensive care staff were blinded to group allocation. Primary outcome measure was duration of postoperative mechanical ventilation. Other outcome measures recorded included total blood products transfused, duration of chest tube in situ, chest tube output, and stays in intensive care and in the hospital.

RESULTS: Sixty infants completed study protocol. Mean age and weight were as follows: group D (n = 19), 61 days, 4.3 kg; group M (n = 20), 64 days, 4.5 kg; and group B (n = 21), 86 days, 4.4 kg. Preoperative and intraoperative characteristics were similar between groups. Ultrafiltrate volumes obtained were 196 ± 93 mL/kg in group D, 105 ± 33 mL/kg in group M, and 261 ± 113 mL/kg in group B. There were no significant differences between groups for any outcome variable. Technical difficulties prevented completion of modified ultrafiltration in 2 of 41 infants.

CONCLUSION: There was no clinical advantage in combining conventional and modified ultrafiltration. Because clinical outcomes were similar across groups, relative risks of the ultrafiltration strategies may influence choice.

Abbreviations and Acronyms ANOVA = analysis of variance; CPB = cardiopulmonary bypass; CUF = conventional ultrafiltration; DCUF = dilutional ultrafiltration; DHCA = deep hypothermic circulatory arrest; ICU = intensive care unit; MUF = modified ultrafiltration; PRBCs = packed red blood cells; PUF = ultrafiltration of prime before onset of CPB; SIRS = systemic inflammatory response syndrome




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