Evaluation of extracorporeal ultrafiltration in the management of refractory congestive heart failure

ABSTRACT

Refractory congestive heart failure [CHF] usually represents the end stage of cardiac disease in which hypotension and oliguria lead to progressive generalized edema. The aim of the present work was to assess the symptomatic response, hemodynamic benefits and side effects of extra-corporeal ultrafiltration [ECUF] therapy in patients with refractory CHF who failed to respond to conventional anti-failure measures. Sixteen patients with refractory CHF who belonged to class IV of the New York Heart Association [NYHA] classification were included in this study. They were 7 men and 9 women with ages ranging from 32 to 63 yr [mean 47 +/- 9 yr]. The causes of heart failure were ischemic heart disease in 3 patients, rheumatic heart disease in 5 and dilated cardiomyopathy in 8. All patients had ECUF therapy, 1-6 sessions/patient, each lasting 4-6 hr with an average amount of ultrafiltrate 2.6 +/- 0.4 L/session. All patients had serial echocardiography, hemodynamic monitoring, chest X-ray, serum electrolyte and hematocrit estimation in addition to routine laboratory tests both pre- and post ECUF. Response to ECUF was considered according to improvement of patients' clinical status, and cardiac and renal functions. Eleven patients were responders [68.5%], 3 were partial responders [18.5%] while 2 were non-responders [13%]. In responder group, edema disappeared, 5 patients [31%] became NYHA class III, with significant diuresis and decrease of body weight. In addition, there was a significant reduction in heart rate, central venous pressure and radiographic cardiothoracic ratio. After ECUF there was a significant increase of serum sodium concentration whereas no-significant changes were observed in serum calcium, potassium, urea or creatinine. By echo cardiography there was a significant reduction in all cardiac chamber dimensions with significant improvement of left ventricular contractility. ECUF offers a reasonably effective and relatively safe method in the therapeutic options of refractory CHF