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J Thorac Cardiovasc Surg 1998;115:361-370
© 1998 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
Sponsor:
From the Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom,a and the Childrens Hospital of Philadelphia, Philadelphia, Pa.b
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 7, 1997; revisions requested June 9, 1997; revisions received Oct. 23, 1997; accepted for publication Oct. 23, 1997. Address for reprints: Michael J. Davies, FRCS, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, United Kingdom.
Objective: Our objective was to test the hypothesis that use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function in children.
Methods: Twenty-one infants undergoing cardiopulmonary bypass were instrumented with ultrasonic dimension transducers, to measure the anteroposterior minor axis diameter, and a left ventricular micromanometer. Patients were randomized to modified ultrafiltration (n = 11, age 226 ± 355 days, weight 6.7 ± 3.1 kg) or control (n = 10, age 300 ± 240 days, weight 7.0 ± 2.5 kg) (all differences p > 0.05 between groups). Left ventricular systolic function was assessed by means of the slope of the preload-recruitable stroke work index. Myocardial cross-sectional area was measured by echocardiography. Data were acquired immediately after separation from bypass, at steady state, and during transient vena caval occlusion. Data acquisition was repeated after 13 ± 5 minutes of modified ultrafiltration or after 12 ± 5 minutes without modified ultrafiltration in the control group. Inotropic drug support was the same at both study points.
Results: In the modified ultrafiltration group, the filtrate volume was 363 ± 262 ml. The hematocrit value increased from 26.0% ± 2.7% to 36.7% ± 9.5% (p = 0.018), myocardial cross-sectional area decreased from 3.72 ± 0.35 cm2 to 3.63 ± 0.36 cm2 (p = 0.04), end-diastolic length increased from 25.6 ± 9.0 mm to 28.8 ± 9.9 mm (p = 0.01), and end-diastolic pressure fell from 5.6 ± 0.8 mm Hg to 4.2 ± 0.8 mm Hg (p = 0.005), suggesting an improved diastolic compliance. In the control group, the hematocrit value, myocardial cross-sectional area, end-diastolic length, and pressure did not change (all p > 0.05). Mean ejection pressure increased in the ultrafiltration group (p = 0.001) but did not change in the control group (p = 0.22). The slope of the preload-recruitable stroke work index increased after ultrafiltration from 52.3 ± 52.0 to 74.2 ± 66.0 (103 erg/cm3) (p = 0.02) but did not change in the control group (p = 0.07). One patient from each group died in the postoperative period. Patients in the ultrafiltration group received less inotropic drug support in the first 24 hours after the operation (156.62 ± 92.31 µg/kg in 24 hours) than patients in the control group (865.33 ± 1772.26 µg/kg in 24 hours, p = 0.03).
Conclusions: Use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function, improves diastolic compliance, increases blood pressure, and decreases inotropic drug use in the early postoperative period.
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