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Ann Thorac Surg 1997;64:43
© 1997 The Society of Thoracic Surgeons
DR ROSS M. UNGERLEIDER (Durham, NC): Doctor Koutlas, that was very nice. As you know, our group has also had a great interest in MUF. This takes time in the operating room, and we have been looking for reasons to justify the use of modified filtration. And although we have looked at this in animal models and a little bit in clinical models, as you so well pointed out in your introduction, your report does emphasize some potential clinical advantage to MUF in a complex group of patients. In particular you emphasize that by using MUF you had less bleeding, which probably accounted for less blood use in those patients and fewer pleural effusions.
What I am curious about is, do you think this is related to the ultrafiltration-because it is curious that most people who criticize ultrafiltration criticize it in part because it may cause more bleeding in their personal experience-or is it related in part to the control group? Because this is a nonrandomized, nonprospective study, I wonder about your control group. Were they older patients or larger patients? Could the control group that you used for your non-MUF patients in part explain the incidence of pleural effusions, because they may have been different in some subtle way from the patients in whom you used MUF? In our experience, for example, we found that MUF is not as effective in older and larger patients, and if those were in your control group, it may explain your findings.
I would be interested to know how you would explain your findings of less bleeding and less pleural effusions on the basis of MUF as opposed to perhaps other variables not accounted for in your study design, but overall this is an excellent study and may be giving us further reasons for using this technique to improve outcomes for our patients.
DR KOUTLAS: Thank you, Dr Ungerleider. I agree the control group in this study is not as strong as if it was a randomized study; however, we saw pretty dramatic results when we began using MUF with regard to blood loss. Our blood utilization strategies were essentially unchanged throughout the study period, and it really seemed that patients had less bleeding after operation using MUF. And I think the data show that.
With regard to effusions, I cannot really explain our results because I am not sure the etiology of postoperative effusions after modified Fontan repair is known. It may be related to what we remove through the ultrafiltration membrane. It may be related to giving less blood. It may be related to less total body water after the operation as opposed to the nonmodified ultrafiltration group. I did not look at hemodynamics specifically in the preoperative evaluation of these patients. I did look at age, size, and diagnosis, and they were virtually identical between the two groups.
DR CLINTON E. BAISDEN (Temple, TX): I had just one quick question. Did you look at postoperative atrial arrhythmias or any other type of arrhythmias, and was there any difference in the two groups?
DR KOUTLAS: Postoperative atrial arrythmias after Fontan repair were not addressed in this study. We do, however, have an ongoing prospective study of this common problem.
DR D. GLENN PENNINGTON (Winston-Salem, NC): Was there an incidence of chylothorax? And if so, was that altered by the use of the ultrafiltration?
DR KOUTLAS: We did not really look at chylothorax per se. Some of these patients had chylous effusions, but none of these patients had the typical long-term type of effusions that were seen before fenestrations of Fontans began; in other words, none of these patients required a catheter for more than a week and none of these effusions occurred late.
DR SCOTT M. BRADLEY (Charleston, SC): Did any of the patients receive antifibrinolytics including aprotinin? And if so, was there any difference between the groups?
DR KOUTLAS: Nobody received aprotinin in either of these two groups.
Related Article
Ann. Thorac. Surg. 1997 64: 37-42.
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