Modified Ultrafiltration Reduces Postoperative Morbidity After Cavopulmonary Connection

Koutlas, Theodore C.; Gaynor, J. William; Nicolson, Susan C.; Steven, James M.; Wernovsky, Gil; Spray, Thomas L.

doi:10.1016/s0003-4975(97)00505-5

Cited by 129 publications

(95 citation statements)

References 15 publications

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“…15,16 Observations made in the pediatric population, including high-risk patients, have shown that ultrafiltration after cardiopulmonary bypass is associated with a mortality rate similar to the estimate for control patients. 7,9,11,12,14 Apparently, the severity of heart disease and the complexity of the operation have a more direct influence on operative mortality than bypass-related inflammatory reaction. The fact that the majority of early casualties in this study were due to untoward cardiac events would support this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Luciani

Menon²,

Vecchi³

et al. 2001

Circulation

107

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Background-Extracorporeal circulation contributes to morbidity after open-heart surgery by causing a systemic inflammatory reaction. Modified ultrafiltration is a technique able to remove the fluid overload and inflammatory mediators associated with use of cardiopulmonary bypass. It has been shown to reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. Methods and Results-Five hundred seventy-three consecutive adult patients were prospectively randomized to either ultrafiltration after cardiopulmonary bypass (treatment) or to no ultrafiltration (control). Parsonnet score was used to assess the severity of the patients' clinical conditions.

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Section: Discussionmentioning

confidence: 99%

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Luciani

Menon²,

Vecchi³

et al. 2001

Circulation

107

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“…6 Finally, all are exposed to the psychological stress of having chronic cardiac disease. 7 As the mortality risk for the Fontan operation has declined, 8,9 the quality of life of survivors has come into focus. The purpose of the present study was to characterize cognitive function and academic achievement after the Fontan operation and to identify potential patient-and procedurerelated risk factors influencing long-term cognitive outcome.…”

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confidence: 99%

Cognitive development after the Fontan operation

Wernovsky

Tiles

Gauvreau

2001

ACC Current Journal Review

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Background-Patients with a single ventricle have multiple risk factors for central nervous system injury, both before and after the Fontan procedure. Methods and Results-A geographically selected cohort was invited to undergo standardized testing, including age-appropriate measures of intelligence quotient (IQ) and achievement tests. Historical information was obtained by chart review and patient questionnaires. Of the 222 eligible patients, 133 (59.9%) participated. Median age at testing was 11.1 years (range, 3.7 to 41.0 years), 6.0 years (range, 1.6 to 19.6 years) after surgery. Mean full-scale IQ was 95.7Ϯ17.4 (PϽ0.006 versus normal); 10 patients (7.8%) had full-scale IQ scores Ͻ70 (Pϭ0.001). After adjustment for socioeconomic status, lower IQ was associated with the use of circulatory arrest before the Fontan operation (Pϭ0.002), the anatomic diagnoses of hypoplastic left heart syndrome (PϽ0.001) and "other complex" (Pϭ0.05), and prior placement of a pulmonary artery band (Pϭ0.04). Mean composite achievement score was 91.6Ϯ15.4 (PϽ0.001 versus normal); 14 patients (10.8%) scored Ͻ70 (PϽ0.001). After adjustment for socioeconomic status, independent risk factors for low achievement scores included the diagnoses of hypoplastic left heart syndrome (Pϭ0.004) and "other complex" (Pϭ0.003) or prior use of circulatory arrest (Pϭ0.03), as well as a reoperation with cardiopulmonary bypass within 30 days of the Fontan (Pϭ0.01). Conclusions-Most

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“…Ultrafiltration contributes to a reduction in the extracellular fluid and inflammatory mediators [26]. As a routine after Fontan surgery we use milrinone and dopamine in order to prevent low cardiac output.…”

Section: Discussionmentioning

confidence: 99%

Results of the Fontan operation with no early mortality in 248 consecutive patients

2017

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A b s t r a c t Background:The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects. Aim:The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. Methods:In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weighing 14.6 ± 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a "beating heart" without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 ± 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme.Results: All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 ± 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 ± 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke. Conclusions:Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation.

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Modified Ultrafiltration Reduces Postoperative Morbidity After Cavopulmonary Connection

Cited by 129 publications

References 15 publications

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Cognitive development after the Fontan operation

Results of the Fontan operation with no early mortality in 248 consecutive patients

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