Diagnosis-Based Differences in Response of Global Ventricular Performance to Modified Ultrafiltration in Children

Abstract

Background: To determine diagnosis-based differences in the response of global ventricular performance to modified ultrafiltration (MUF) using transesophageal echocardiography during congenital heart surgery. Methods and Results:The study included 38 children with atrial septal defect (n=10), ventricular septal defect (VSD) (n=8), tetralogy of Fallot (TOF) (n=9), or a single ventricle (n=11). Arteriovenous MUF was performed for 10-15 min after cardiopulmonary bypass (CPB). The myocardial performance index (MPI) of the systemic ventricles and the % change in MPI before and after MUF were assessed. Impairment of MPI was noted at termination of CPB compared with baseline values in the VSD and TOF groups (P<0.05). MUF resulted in an improvement in MPI in all groups (P<0.01). There was a weak correlation between aortic cross-clamping or CPB time, and the degree of improvement in MPI (r=−0.385, P=0.019; r=−0.348, P=0.037, respectively). MUF improved fractional shortening in all groups (P<0.05) and reversed abnormal relaxation in the VSD and TOF groups. Conclusions:Modified ultrafiltration ameliorated MPI in all groups, indicating improved systemic ventricular function with MUF. The MPI recovery rate differed among the groups. MUF may be particularly useful for restoring the global ventricular performance of patients undergoing longer CPB and may have minimal advantages for simple open-heart surgery. (Circ J 2010; 74: 86 - 92)

Effect of Limb Ischemic Preconditioning on Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery - A Randomized Controlled Trial -

“…13 The pump priming solution consisted of sufficient crystalloid and 20% albumin to keep the hematocrit value between 25% and 30%. Anticoagulation was accomplished by intravenous administration of heparin sulfate, which was neutralized with protamine sulfate at the end of CPB.…”

Ultrafiltration in Pediatric Cardiac Surgery Review

“…22 They found improved global ventricular function as measured by myocardial performance index as well as fractional shortening with MUF. 22 Interestingly, the magnitude of benefit was negatively correlated with length of CPB and aortic cross-clamp time. 22 Overall, this study, in addition to the study by Chaturvedi et al, showed no change in any diastolic function parameter which adds to the polarity in the literature as Davies et al found improved diastolic performance.…”

“…There is a substantial body of evidence that MUF can hemoconcentrate to this effect. 1,[14][15][16][17][18][19][20][21][22][23][24] Furthermore, there is evidence that higher flow or longer duration of MUF significantly improves the hemoconcentration capabilities. 25,26 Red blood cells (RBCs), platelets, prothrombin (70 kDa), fibrinogen (340 kDa), and albumin (65 kDa) are larger than common ultrafiltrator membrane pore sizes of 60 to 65 kDa and have been shown to be concentrated by MUF; however, smaller coagulation factors such as factor IX (55 kDa) and X (38 kDa) were not.…”

“…22 Interestingly, the magnitude of benefit was negatively correlated with length of CPB and aortic cross-clamp time. 22 Overall, this study, in addition to the study by Chaturvedi et al, showed no change in any diastolic function parameter which adds to the polarity in the literature as Davies et al found improved diastolic performance. 15,22,46 Improvement in global ventricular function by MUF was thought to be related to reduced myocardial edema as a decrease in ventricular wall thickness has been observed.…”

The Effect of Modified Ultrafiltration on Angiopoietins in Pediatric Cardiothoracic Operations

“…MUF was introduced in 1991 and is the process of ultrafiltration immediately following the completion of CPB [2]. In children, MUF has been shown to have clinical benefit by decreasing total body water, improving myocardial contraction, decreasing transfusion requirements and intensive care unit lengths of stay [2,4,5]. The most accepted beliefs for the clinical improvement are the removal of excess free water and its subsequent hemoconcentation effects [2,4].…”