Operatory impact of modified ultrafiltration in pediatric congenital heart disease patients operated with cardiopulmonary bypass

Introduction and objectives: The use of modified ultrafiltration procedure in paediatric cardiac surgery with cardiopulmonary bypass in order to reduce the systemic inflammatory response is controversial. The aim of this study is to demonstrate the usefulness of this procedure for removing pro-inflammatory substances in non-neonatal paediatric patients with non-complex congenital heart disease. Additionally, we aimed to determine its effects on haemoconcentration and in lactate and fluid removal. Methods: A clinical trial was designed that included non-neonatal paediatric patients weighing >5 kg with non-complex congenital heart disease and underwent surgery with cardiopulmonary bypass over a period of one year. They were randomised into a problem group (with modified ultrafiltration) and a control group (without it), and blood samples were taken in order to measure concentrations of interleukins (6 and 10), C3d and C4d complement fractions at the following times: baseline, before cardiopulmonary bypass, after it, after modified ultrafiltration, from the ultrafiltration concentrate, and on discharge from the operating room. Endpoints were defined in terms of morbidity and mortality, pro-inflammatory substances, lactate removal, fluid balance, and haemoconcentration. Results: A total of 13 patients were included in the problem group and 15 in the control group. A significantly lower serum IL-6, IL-10, and lactate at the end of cardiopulmonary bypass, were observed in the problem group, as well as a greater fluid removal, lactate, and C4d concentration in the ultrafiltration product. Conclusions: Modified ultrafiltration may benefit non-neonatal paediatric patients with congenital heart disease operated on with cardiopulmonary bypass, as it is able to decrease serum concentration of IL-6, IL-10, and lactate. Additionally, it can help to filter C4d and remove excess fluid, thus a greater haemoconcentration. Therefore, its routine use is recommended when the haemodynamic conditions are favourable. (C) 2016 Socialad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.