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Ann Thorac Surg 2001;71:684-693
© 2001 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, School of Medicine University of Ankara, Turkey
b Department of Hematology, School of Medicine University of Ankara, Ankara, Turkey
Address reprint requests to Dr Kiziltepe, Sokollu Cad. Nakis Sok. 8/14 Dikmen, Ankara, 06460 Turkey
e-mail: uk9316{at}hotmail.com
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. Modified ultrafiltration (MUF) improves hemodynamics and postoperative recovery in children. Ultrafiltration (UF) may have similar benefits in adults. The purpose of this study was to investigate the effects of UF in adult patients.
Methods. A total of 40 adult patients undergoing cardiac surgery were randomized into a study group of conventional UF during bypass + venovenous MUF after bypass and a control group with no UF. Perioperative clinical variables, cytokines, and endothelin-1 levels were compared between groups.
Results. There was no mortality in either group. The patients in the study group had a greater rise in hematocrit (5.7% ± 2.4% vs 1.2% ± 1.9%, p < 0.001), hemoglobin (1.7 ± 0.8 mg/mL vs 0.5 ± 0.6 mg/mL, p < 0.0005), and platelet levels (27,800 ± 29,200 vs -9,000 ± 30970, p < 0.001). Mean arterial blood pressure and CI increased after MUF (from 64.2 ± 16.9 mm Hg to 72.3 ± 14.1 mm Hg, p = 0.05, and from 2.4 ± 0.7 to 2.8 ± 0.6, p < 0.03, respectively). Postoperative oxygenation was better in the study group (alveolo-arterial PO2 tension gradient 74.6 ± 43.9 mm Hg vs 107.2 ± 27.8 mm Hg, p = 0.03). Ultrafiltration reduced postoperative bleeding (522.2 ± 233.4 mL vs 740 ± 198.4 mL, p < 0.003).
Conclusions. A combination of conventional and modified UF is effective and safe in adult patients undergoing cardiac surgery. Ultrafiltration improved hemodynamics, hemostatic, and pulmonary functions. We recommend the use of combined UF in high-risk adult patients.
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