Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass

M. J. Davies, K. Nguyen, J. W. Gaynor, M. J. Elliott, M. R. De Leval, P. A. Penkoske, C. W. Daggett

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Abstract

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 ± 035 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 523 ± 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.

Original languageEnglish
Pages (from-to)361-370
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume115
Issue number2
DOIs
StatePublished - 1998

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