Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Background: Extracorporeal circulation contributes to
morbidity after open-heart surgery by causing a systemic
inflammatory reaction. Modified ultrafiltration is a technique able
to remove the fluid overload and inflammatory mediators associated
with use of cardiopulmonary bypass. It has been shown to reduce
morbidity after cardiac operations in children, but the impact on
adult cardiac procedures is unknown.

Methods and
Results: Five hundred seventy-three consecutive adult patients
were prospectively randomized to either ultrafiltration after
cardiopulmonary bypass (treatment) or to no ultrafiltration
(control). Parsonnet score was used to assess the severity of the
patients’ clinical conditions. Analysis was done with Student’s t
test or Mann-Whitney U test for continuous variables and Fisher’s
exact test or Pearson’s 2 for discrete variables. Hospital mortality
was 2.5% (7 of 284) in the treatment group versus 3.8% (11 of 289)
in the control group (P=0.357). Hospital morbidity was lower in
treated patients (66 of 284 [23.2%] versus 117 of 289 [40.5%],
P=0.0001). Cardiac morbidity was similar (26 of 284 [9.1%] versus 35
of 289 [12.1%], P=0.251), whereas significantly lower rates of
respiratory (20 of 284 [7.0%] versus 36 of 289 [12.5%], P=0.029),
neurological (5 of 284 [1.8%] versus 14 of 289 [4.8%], P=0.039), and
gastrointestinal (0 of 284 versus 4 of 289 [1.4%], P=0.044)
complications were found in treated patients. Transfusion
requirements were also lower in treated patients (1.66±2.6 versus
2.25±3.8 U/patient, P=0.039). Duration of intensive care (39.9±49.2
versus 46.3±72.8 hours, P=0.218) and hospital stay (7.6±3.5 versus
7.9±4.4 days, P=0.372) were comparable.

Conclusions: 
Modified ultrafiltration after cardiopulmonary bypass is associated
with a lower prevalence of early morbidity and lower blood
transfusion requirements. The impact on length of hospital stay
needs further analysis. Routine application of modified
ultrafiltration after adult cardiac operations is warranted.

Division of Cardiac
Surgery, University of Verona, Verona, Italy.


Correspondence to Giovanni Battista Luciani, MD,
Division of Cardiac Surgery, University of Verona, OCM Piazzale
Stefani 1, Verona, 37126, Italy. E-mail [email protected]