A comparative study of hemodynamics after cardiac surgery with venous-arterial modified ultrafiltration and aterial-venous modified ultrafiltration in infants / 中华胸心血管外科杂志

Objective Evaluate the effects of venous-arterial modified ultrafiltration on hemodynamics compared to arterial-venous in children undergoing cardiopulmonary bypass (CPB) for repair of congenital heart defects. Methods Forty patients underwent MUF randomly divided into two groups,group V-A MUF (n =20) and group A-V MUF (n =20) for 10 min after CPB. They were studied before CPB, after CPB, 10 min after CPB, and 30 min after CPB. Haemodynamic data including heart rate, blood pressure, central venous pressure and hematocrit were recorded. Transoesophaegeal echocardiography determined left ventricular posterior wall thickness in end-systole ( LVPWs) and end-diastole (LVPWd) , end diastolic volume (EDV) , end systolic volume (ESV) and ejection fraction (EF) were measured and compared in two groups. Results Patients in V-A MUF maintained better systolic arterial blood pressure at 10 min and 30 min compared with 0 min values after CPB. A significant decrease in EF were observed in both groups immediately after CPB ( P < 0.05 ). Significant increase in EF was observed at 10 min (60% ) and 30 min (46% ) after CPB compared with 0 min value after bypass in V-A MUF (P <0.001 ). In A-V MUF, no such increase in EF was observed. EF were significantly higher at 10 min and 30 min in V-A MUF as compared with A-V MUF (P < 0. 001). There was also significant improvement in posterior wall thickness in V-A MUF (P <0.05). Haematocrit values were not different in duration of postoperative between two groups. Conclusion Veno-arterial modified ultrafiltration is a safe and effective method of improving hemodynamics in children following cardiac surgery.

Hemodynamic Effects of Modified Ultrafiltration (MUF) in Adult Patients Undergoing Valvular Heart Surgery / 대한마취과학회지

BACKGROUND: Modified ultrafiltration (MUF) has been demonstrated to have beneficial effects in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). In adults, the hemodynamic effects of MUF are little known. The purpose of this investigation is to evaluate the hemodynamic effects of MUF in adult patients undergoing valvular heart surgery. METHODS: 30 patients scheduled for elective mitral valvular surgery were randomized into either Ultrafiltration (U) or Control (C) group. In the U group, MUF was performed just after termination of CPB for 20 minutes, and not in the C group. Measurements of hemodynamic variables including right ventricular ejection fraction (RVEF) measured by thermodilution technique and hematocrit were performed before induction, just after termination of CPB, after completion of MUF and after sternal closure. Measurement after MUF in the C group was performed at 20 minutes after the termination of CPB. After transfer to ICU, same measurements were performed at postoperative 6 and 12 hrs. RESULTS: After MUF, RVEF (P < 0.05) and hematocrit (P < 0.01) increased in the U group, compared to the corresponding values measured just after termination of CPB. However, the variables were not statistically different between the two groups throughout the intraoperative procedures and during ICU stay. CONCLUSIONS: Conclusively, MUF was demonstrated to have the transient beneficial effect of improving the right heart function and hemoconcentration immediately after termination of CPB.

Effects of Modified Ultrafiltration in Pediatric Cardiac Surgery / 日本心臓血管外科学会雑誌

Modified ultrafiltration (MUF) for cardiopulmonary bypass (CPB) in children decreases total body water and improves left heart function. We investigated the effects of MUF in pediatric open-heart surgery. Eighty-six patients less than 15kg who underwent radical cardiac operation were divided into four groups according to whether they received transfusion during the operation or not, and whether MUF was performed after completion of CPB or not. MUF group showed significantly higher hematocrit levels 20min after the end of CPB compared with non-MUF group in both transfused group and non-transfused group. Then, MUF group showed a significantly higher serum protein level than non-MUF group. In MUF groups, the systolic blood pressure elevated without the elevation of the left atrial pressure. We calculated PaO₂/FiO₂ as an index of postoperative lung function. The postoperative PaO₂/FiO₂ of MUF group was significantly higher than that of non-MUF group in transfused group. MUF significantly decreased homologous blood transfusion during the operation. MUF after CPB elevated hematocrit level and serum protein level, and improved cardiac function without volume load. Since MUF reduced the need for homologous blood transfusion. MUF is a useful means for pediatric cardiac surgery.