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J Thorac Cardiovasc Surg 1999;117:496-505
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

VENOVENOUS MODIFIED ULTRAFILTRATION AFTER CARDIOPULMONARY BYPASS IN CHILDREN: A PROSPECTIVE RANDOMIZED STUDY

From Schneider Children's Hospital of the Long Island Jewish Medical Center,^a University of Michigan Medical Center,^b and the Albert Einstein College of Medicine,^c New Hyde Park, NY.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested June 11, 1998. Revisions received Nov 12, 1998. Accepted for publication Nov 12, 1998. Address for reprints: Hani A. Hennein, MD, Section of Pediatric Cardiothoracic Surgery, Schneider Children's Hospital of the Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11040.

Background: Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass.
Methods: Thirty-eight pediatric patients were randomly assigned to undergo conventional, venovenous (n = 13), or no ultrafiltration venovenous (n = 13), and controls (n = 12). Perioperative, cardiopulmonary, and cytokine (tumor necrosis factor–, interleukin-1ß, interleukin-6, interleukin-8, and interleukin-10) data were collected for statistical analysis.
Results: Compared with patients in the conventional ultrafiltration and control groups, patients undergoing venovenous modified ultrafiltration had the greatest volume of ultrafiltrate removed (46.9 ± 8.4 mL/kg vs 20.1 ± 5.0 mL/kg and 0 mL/kg for conventional ultrafiltration and control groups, respectively; P = .0001), least increase in total body water (1.91% ± 1.49% vs 3.90% ± 1.86% and 8.24% ± 3.41%; P = .05), greatest rise in hematocrit (39.7% ± 1.7% vs 33.8% ± 2.1% and 29.6% ± 2.3%; P = .006), and shortest length of hospital stay (4.41 ± 0.28 days vs 6.69 ± 1.47 days and 8.38 ± 1.11 days; P = .03, P = .03).
Conclusions: Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.

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