Effects of modified ultrafiltration and conventional ultrafiltration combination on perioperative clinical outcomes in pediatric cardiac surgery

Abstract

Background: This meta-analysis was performed to review the effects of the addition of modified ultrafiltration (MUF) and conventional ultrafiltration (CUF) to CUF alone on postoperative hemoglobin, surgical and ultrafiltration data, and postoperative clinical outcomes in pediatric patients undergoing cardiac surgery. Methods: A systematic search was performed to identify randomized controlled clinical trials that compared MUF and CUF combination with CUF alone in pediatric cardiac surgery undergoing cardiopulmonary bypass (CPB) in PubMed, Embase, Cochrane Library, and Web of Science without any language or date limitation in February 2020. For each included trial, the primary outcomes including post-CPB and postoperative hematocrit, surgical and ultrafiltration data, postoperative clinical outcomes including volume of chest tube drainage within 48 hours after surgery and perioperative blood requirement, ventilation support duration, and length of stay day in the intensive care unit (ICU) and hospital were collected and analyzed. The analysis was conducted using STATA version 12.0. Results: A total of 8 trials encompassing 405 patients were included in this analysis. Analysis indicated that MUF + CUF increased the post-CPB hematocrit (Standard mean difference, SMD = 1.85, 95% confidence interval, 95% CI 0.91–2.79). Meanwhile, ultrafiltration volume was higher in CUF+MUF infants than CUF-alone infants (SMD = 1.46, 95% CI 0.51–2.41, P = .003). The clinical outcomes, including postoperative hemodynamic changes, prime volume, blood requirement, chest tube drainage volume, mechanical ventilation duration, and ICU duration, were unclear because of the unstable sensitivity analyses. Conclusions: Beneficial effects of using MUF and CUF for pediatric cardiac surgery, including increase post-CPB hematocrit and ultrafiltration volume when compared with CUF alone. Meanwhile, MUF and CUF did not significantly influence the postoperative hospital stay duration, CPB, and aortic occlusion duration.

Modified Ultrafiltration Improves Lung Mechanics in Congenital Cardiac Surgery - A Fact or Futile: A Prospective, Observational, Single-Center Study

“…Our results regarding Hb improvement in patients with MUF match the outcome from a meta-analysis by Hu et al [8], indicating the role of this procedure in increasing post-operative hematocrit or Hb. This outcome relates to the body water elimination capacity of MUF, leading to an increase in red blood cell/hematocrit levels.…”

“…The current findings concerning the decline in P plat , Re, and WOB concorded with the results of Meliones et al [39], Torina et al Contrary to the literature findings, MUF had no statistically significant impact on P mean , C-stat, and Cdyn [39]. Alternatively, the rationale behind the possible influence of MUF on lung mechanics is the potential of this procedure to minimize inflammatory reactions and remove excess water [6,8,40]. Of note, this technique also assists in recovering vena cava blood (~70 mL), which consequentially improves pulmonary circulation [42].…”

“…MUF reduces hemodilution by conserving blood cells and can be used in infants after administering conventional ultrafiltration [8]. Of note, MUF is known to reduce operative mortality and morbidity in infants treated with CPB [9].…”

Severe hypoalbuminemia complicating a successful atrial switch operation (Senning) with cardiopulmonary bypass - report on a rare case

“…In addition, MUF can eliminate excess water and ameliorate inflammatory reactions, and considerable increases platelet count, haematocrit, plasma protein, prothrombin, factor VII, and fibrinogen levels which may influence the complications, duration of mechanical ventilation, intensive care unit (ICU) stay, inotropic support, blood transfusions, and total hospitalization after complex congenital cardiac surgeries. 3 We describe a successful management of a 3 months old-male child, weighing 3.5 kg with dextrotransposition of great arteries (D-TGA) with regressed LV undergoing an atrial switch (Senning procedure), who developed an unusual complication in the ICU, i.e. severe hypoproteinaemia resulting in acute kidney injury (AKI) with complete anuria, generalized anasarca, difficult weaning from ventilator, and systemic hypotension requiring inotropes and vasopressors.…”