Volume 2, Issue 2, June 2018, Page: 23-28
Use of Conventional Ultrafiltration in Patients with Pulmonary Hypertensive Mitral Valve Disease Undergoing Valve Surgery
Burak Can Depboylu, Department of Cardiovascular Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
Serkan Yazman, Cardiovascular Surgery Clinic, Mugla Sitki Kocman University, Training and Research Hospital, Mugla, Turkey
Bugra Harmandar, Department of Cardiovascular Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
Received: Apr. 24, 2018;       Accepted: May 14, 2018;       Published: Jun. 12, 2018
DOI: 10.11648/j.ccr.20180202.12      View  695      Downloads  47
Adverse effects of cardiopulmonary bypass on blood and lungs are encountered more severelyin pulmonary hypertensive patients undergoing mitral valve surgery. Aim of this study is to identify the favorable effects of conventional ultrafiltration on postoperative pulmonary functions, hemodynamics, morbidity or mortality in pulmonary hypertensive patients undergoing mitral valve surgery. 40 patients with severe pulmonary hypertension who underwent mitral valve surgery were included in study. Patients were divided into two groups according to whether conventional ultrafiltration was applied or not. Demographic data, preoperative transthoracic echocardiography, respiratory functions, complete blood count, biochemical parameters, alterations in pulmonary functions, bleeding, use of inotropic agents and blood products, intubation time, mortality, morbidity, length of intensive care unit and hospital stay, were evaluated. Intubation time (7.97±2.77 vs. 10.12±2.95; p<0.05), intensive care stay (42.20±65.99 vs. 44.25±14.13; p<0.05), hospital stay (7.20±1.13 vs. 10.12±3.27; p<0.05), bleeding (370.00±216.28 vs. 506.25±247.03; p<0.05) were significantly shorter in study group. Use of blood products (4.20±1.23 vs. 4.90±2.13; p>0.05) and inotropic agents (14 vs. 18; p>0.05) were less than the control group. Increase of pulmonary compliance, cardiac index, oxygen index, decrease of alveolar-arterial oxygen pressure difference and ventilation index were significant in both groups. Hematocrit (28.07±3.18 vs. 26.96±2.51; p>0.05) and white blood cell (13.56±2.37 vs. 13.03±2.51; p>0.05) were higher in the study. No morbidity and mortality were presentin both groups. Conventional ultrafiltration decreased the intubation time, intensive care unit stay, hospital stay, bleeding, use of blood products and inotropic agents. Favorable effects were also detected on pulmonary compliance, cardiac index, oxygen index, alveolar-arterial oxygen pressure difference and ventilation index. Studies with larger patient population, application of conventional and modified ultrafiltration together may give significant results for pulmonary functions.
Cardiopulmonary Bypass, Cardiac Surgery, Mitral Valve Disease, Ultrafiltration, Morbidity
To cite this article
Burak Can Depboylu, Serkan Yazman, Bugra Harmandar, Use of Conventional Ultrafiltration in Patients with Pulmonary Hypertensive Mitral Valve Disease Undergoing Valve Surgery, Cardiology and Cardiovascular Research. Vol. 2, No. 2, 2018, pp. 23-28. doi: 10.11648/j.ccr.20180202.12
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Schlant RC, Alexander RW. Techniques of evaluating pulmonary function in patients with cardiac disease in Hurst’s The Heart, 8th ed., New York, McGraw-Hill, 1994. 441-445p.
Mahmoud AB, Burhani MS, Hannef AA, Jamjoom AA, Al-Githmi IS, Baslaim GM. Effect of modified ultrafiltration on pulmonary function after cardiopulmonary bypass. Chest. 2005; 128:3447-3453.
Huang H, Yao T, Wang W, Zhu D, Zhang W, Chen H, Fu W. Continuous ultrafiltration attenuates the pulmonary injury that follows open heart surgery with cardiopulmonary bypass. Ann Thorac Surg. 2003; 76:136-140.
Kiziltepe U, Uysalel A, Corapcioglu T, Dalva K, Akan H, Akalin H. Effects of combined conventional and modified ultrafiltration in adult patients. Ann Thorac Surg. 2001; 71:684-693.
Boodhwani M, Williams K, Babaev A, Gill G, Saleem N, Rubens FD. Ultrafiltration reduces blood transfusions following cardiac surgery: A meta-analysis. Eur J Cardiothorac Surg. 2006; 30:892-897.
Hall R. Identification of inflammatory mediators and their modulation by strategies for the management of the systemic inflammatory response during cardiac surgery. J Cardiothoracic Vasc Anesth. 2013; 27:983-1033.
Redlin M, Kukucka M, Boettcher W, Schoenfeld H, Huebler M, Kuppe H, Habazettl H. Blood transfusion determines postoperative morbidity in pediatric cardiac surgery applying a comprehensive blood-sparing approach. J ThoracCardiovasc Surg. 2013; 146:537-542.
Salvin JW, Scheurer MA, Laussen PC, Wypij D, Polito A, Bacha EA, Pigula FA, McGowan FX, Costello JM, Thiagarajan RR. Blood transfusion after pediatric cardiac surgery is associated with prolonged hospital stay. Ann Thorac Surg. 2011; 91:204-210.
Wolf MJ, Maher KO, Kanter KR, Kogon BE, Guzzeta NA, Mahle WT. Early postoperative bleeding is independently associated with increased surgical mortality in infants after cardiopulmonary bypass. J ThoracCardiovasc Surg. 2014; 148:631-636.
Society of Thoracic Surgeons Blood Conservation Guideline Task Force, Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, Song HK, Clough ER; Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Shore-Lesserson LJ, Goodnough LT, Mazer CD, Shander A, Stafford-Smith M, Waters J; International Consortium for Evidence Based Perfusion, Baker RA, Dickinson TA, FitzGerald DJ, Likosky DS, Shann KG. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011; 91:944-982.
Torina AG, Silveira-Filho LM, Vilarinho KA, Eghtesady P, Oliveira PP, Sposito AC, Petrucci O. Use of modified ultrafiltration in adults undergoing coronary artery bypass grafting is associated with inflammatory modulation and less postoperative blood loss: a randomized and controlled study. J ThoracCardiovasc Surg. 2012; 144:663-670.
Kosour C, Dragosavac D, Antunes N, Almeida de Oliveira RA, Martins Oliveira PP, Wilson Vieira R. Effect of ultrafiltration on pulmonary function and interleukins in patients undergoing cardiopulmonary bypass. CardiothoracVascAnesth. 2016; 30:884-890.
Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017; 61:760-767.
Atkins BZ, Danielson DS, Fitzpatrick CM, Dixon P, Petersen RP, Carpenter AJ. Modified ultrafiltration attenuates pulmonary-derived inflammatory mediators in response to cardiopulmonary bypass. Interact CardiovascThorac Surg. 2010; 11:599-603.
Raja SG, Dreyfus GD. Modulation of systemic inflammatory response after cardiac surgery. Asian CardiovascThorac Ann. 2005; 13:382-395.
Chew MS, Brix-Christensen V, Ravn HB, Brandslund I, Ditlevsen E, Pedersen J, Hjortholm K, Hansen OK, Tønnesen E, Hjortdal VE. Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: a prospective, randomized study. Perfusion. 2002;17: 327-333.
Grunenfelder J, Zund G, Schoeberlein A, Maly FE, Schurr U, Guntli S, Fischer K, Turina M. Modified ultrafiltration lowers adhesion molecule and cytokine levels after cardiopulmonary bypass without clinical relevance in adults. Eur J Cardiothorac Surg. 2000; 17:77-83.
Hannan EL, Wu C, Smith CR, Higgins RS, Carlson RE, Culliford AT, Gold JP, Jones RH. Off-pump versus on-pump coronary artery bypass graft surgery: differences in short-term outcomes and in long-term mortality and need for subsequent revascularization. Circulation. 2007; 116:1145-1152.
Wynne R, Botti M: Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: Clinical significance and implications for practice. Am J Crit Care 2004; 13:384-393.
Cepkova M, KapurV, RenX, Quinn T, Zhuo H, Foster E, Liu KD, Matthay MA. Pulmonary dead space fraction and pulmonary artery systolic pressureas early predictors of clinical outcome in acute lung injury. Chest 2007; 132:836-842.
Koike T, Tsuchida M, Saitoh M, Haga M, Satoh K, Aoki T, Toyabe SI, Hayashi JI. Protective mechanism of ultrafiltration against cardiopulmonary bypass-induced lung injury. Transplant Proc. 2009; 41:3845-3848.
Pérez-Vela JL, Ruiz-Alonso E, Guillén-Ramírez F, García-Maellas MT, Renes-Carreño E, Cerro-García M, Cortina-Romero J, Hernández-Rodríguez I. ICU outcomes in adult cardiac surgery patients in relation to ultrafiltration type. Perfusion. 2008; 23:79-87.
Apostolakis EE, Koletsis EN, Baikoussis NG, Siminelakis SN, Papadopoulos GS. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass. JCardiothorac Surg. 2010; 5:1.
Berdat PA, Eichenberger E, Ebell J, Pfammatter JP, Pavlovic M, Zobrist C, Gygax E, Nydegger U, Carrel T. Elimination of proinflammatory cytokines in pediatric cardiac surgery: Analysis of ultrafiltration method and filter type. J ThoracCardiovasc Surg 2004; 127:1688-1696.
Zhou G, Feng Z, Xiong H, Duan W, Jin Z. A combined ultrafiltration strategy during pediatric cardiac surgery: a prospective, randomized, controlled study with clinical outcomes. J CardiothoracVascAnesth. 2013; 27:897-902.
Ricci Z, Polito A, Netto R, De Razza F, Favia I, Carotti A, Cogo PE. Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery. PediatrCrit Care Med. 2013; 14:390-395.
Yokoyama K, Takabayashi S, Komada T, Onoda K, Mitani Y, Iwata H, Shimpo H. Removal of prostaglandin E2 and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery. J ThoracCardiovascSurg. 2009; 137:730-735.
Hodges UM, Berg S, Naik SK, Bower S, Lloyd-Thomas A, Elliot M. Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children. J CardiothoracVascAnesth. 1994; 8:653-657.
Naik SK, Balaji S, Elliott MJ. Modified ultrafiltration improves hemodynamics after cardiopulmonary bypass in children. J Am CollCardiol. 1992; 19:37A.
Chaturvedi RR, Shore DF, White PA, Scallan MH, Gothard JW, Redington AN, Lincoln C. Modified ultrafiltration improves global left ventricular systolic function after open-heart surgery in infants and children. Eur J Cardiothorac Surg. 1999; 15:742-746.
Keenan HT, Thiagarajan R, Stephens KE, Williams G, Ramamoorthy C, Lupinetti FM. Pulmonary function after modified venovenous ultrafiltration in infants: a prospective, randomized trial. J ThoracCardiovasc Surg. 2000; 119:501–505.
Liu JP, Long C, Feng ZY, Ji BY, Li CH. Comparative study of pulmonary function after conventional ultrafiltration or modified ultrafiltration during cardiac surgery of infants. Zhongguo Yi XueKeXue Yuan XueBao. 2002; 24:364-366.
Onoe M, Oku H, Kitayama H, Matsumoto T, Kaneda T. Modified ultrafiltration may improve postoperative pulmonary function in children with a ventricular septal defect. Surg Today. 2001; 31:586-590.
MongeroL, Stammers A, Tesdahl E, Stasko A, Weinstein S. The effect of ultrafiltration on end-cardiopulmonary bypass hematocrit during cardiac surgery. Perfusion. 2018; 1:267659117747046.
Sever K, Tansel T, Basaran M, Kafali E, Ugurlucan M, Ali Sayın O, Alpagut U, Dayıoglu E, Onursal E. The benefits of continuous ultrafiltration in pediatric cardiac surgery. ScandCardiovasc J 2004;38: 307-311.
Luciani GB, Menon T, Vecchi B, Auriemma S, Mazzucco A. Modified ultrafiltration reduces morbidity after adult cardiac operations: a prospective, randomized clinical trial. Circulation. 2001; 104:I253-259.
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