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Cited by 167Cardiac and Coronary Surgery TechniquesCongenital Heart Disease StudiesMechanical Circulatory Support Devices

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Modified Ultrafiltration Improves Left Ventricular Systolic Function In Infants After Cardiopulmonary Bypass

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Davies, Michael J., Nguyen, Khan, Gaynor, J.William, Elliott, Martin J.·1998·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1016/s0022-5223(98)70280-6
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Abstract

Objective Our objective was to test the hypothesis that use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function in children. Methods Twenty-one infants undergoing cardiopulmonary bypass were instrumented with ultrasonic dimension transducers, to measure the anteroposterior minor axis diameter, and a left ventricular micromanometer. Patients were randomized to modified ultrafiltration (n = 11, age 226 +/- 355 days, weight 6.7 +/- 3.1 kg) or control (n = 10, age 300 +/- 240 days, weight 7.0 +/- 2.5 kg) (all differences p > 0.05 between groups). Left ventricular systolic function was assessed by means of the slope of the preload-recruitable stroke work index. Myocardial cross-sectional area was measured by echocardiography. Data were acquired immediately after separation from bypass, at steady state, and during transient vena caval occlusion. Data acquisition was repeated after 13 +/- 5 minutes of modified ultrafiltration or after 12 +/- 5 minutes without modified ultrafiltration in the control group. Inotropic drug support was the same at both study points. Results In the modified ultrafiltration group, the filtrate volume was 363 +/- 262 ml. The hematocrit value increased from 26.0% +/- 2.7% to 36.7% +/- 9.5% (p = 0.018), myocardial cross-sectional area decreased from 3.72 +/- 0.35 cm2 to 3.63 +/- 0.36 cm2 (p = 0.04), end-diastolic length increased from 25.6 +/- 9.0 mm to 28.8 +/- 9.9 mm (p = 0.01), and end-diastolic pressure fell from 5.6 +/- 0.8 mm Hg to 4.2 +/- 0.8 mm Hg (p = 0.005), suggesting an improved diastolic compliance. In the control group, the hematocrit value, myocardial cross-sectional area, end-diastolic length, and pressure did not change (all p > 0.05). Mean ejection pressure increased in the ultrafiltration group (p = 0.001) but did not change in the control group (p = 0.22). The slope of the preload-recruitable stroke work index increased after ultrafiltration from 52.3 +/- 52.0 to 74.2 +/- 66.0 (10[3] erg/cm3) (p = 0.02) but did not change in the control group (p = 0.07). One patient from each group died in the postoperative period. Patients in the ultrafiltration group received less inotropic drug support in the first 24 hours after the operation (156.62 +/- 92.31 microg/kg in 24 hours) than patients in the control group (865.33 +/- 1772.26 microg/kg in 24 hours, p = 0.03). Conclusions Use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function, improves diastolic compliance, increases blood pressure, and decreases inotropic drug use in the early postoperative period.

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  • Exposure of blood elements to the foreign surface of the bypass circuit induces a systemic inflammatory response, leading to capillary leak, edema formation, and myocardial diastolic and systolic dysfunction.

    “The exposure of the patient’s blood elements to the foreign surface of the bypass circuit induces a systemic inflammatory response, leading to capillary leak, edema formation, and myocardial diastolic and systolic dysfunction [3-6].”

    From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [5]

    The introductory passage (page unavailable) links pediatric cardiopulmonary bypass with inflammatory capillary leak, increased tissue water, edema, and organ dysfunction. The Discussion (page unavailable) links myocardial edema with impaired diastolic compliance and systolic function, but does not identify blood contact with the circuit’s foreign surface as the trigger; it also says the timing of systolic improvement weighs against an inflammatory explanation. (LLM, conf=0.87)

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  • The systemic and regional inflammatory response with cardiopulmonary bypass and reperfusion injury increases total body oxygen demand while impairing oxygenation, cardiac output, and systemic oxygen delivery.

    “The systemic and regional inflammatory response that occurs with cardiopulmonary bypass and reperfusion injury increases total body oxygen demand while impairing oxygenation, cardiac output and systemic oxygen delivery [3-6].”

    From Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease (2016) · cites this paper as [5]

    The Abstract (page unavailable) links cardiopulmonary bypass in children to an inflammatory capillary leak, tissue edema, and subsequent organ dysfunction, including cardiac and pulmonary edema. It does not state that this response increases total-body oxygen demand or impairs oxygenation, cardiac output, and systemic oxygen delivery; the Discussion (page unavailable) explicitly says oxygen delivery was not examined. (LLM, conf=0.83)

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Research works printed but not linked: 24

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  18. Hodges, 1994, Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children, J Cardiothorac Vasc Anesth, 8, 653, 10.1016/1053-0770(94)90197-X · DOI
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Metadata

Authors
Davies, M. J., Nguyen, K., Gaynor, J. W., & Elliott, M. J.
Affiliations
  • Great Ormond Street Hospital (GB)
  • Children's Hospital of Philadelphia (US)
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
1998-02
Volume
115
Issue
2
Pages
361-370
ISSN
0022-5223 (ISSN-L)
DOI
10.1016/s0022-5223(98)70280-6
OpenAlex
W2122228940
Cited by
167
References
0
Citations by year
2026: 3 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 6
FWCI
10.75
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
Keywords
modified ultrafiltration, cardiopulmonary bypass, left ventricular systolic function, infants, postoperative cardiac function, diastolic compliance, vena caval occlusion, stroke work index, hematocrit, ejection pressure, postoperative hemodynamic support, pediatric cardiac surgery
MeSH terms
Cardiopulmonary Bypass, Cardiotonic Agents, Echocardiography, Female, Heart Function Tests, Hematocrit, Hemofiltration, Humans, Infant, Male, Myocardial Contraction, Ventricular Function, Left, Ventricular Dysfunction, Left

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