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CLINICAL STUDIES

Effect of veno-venous ultrafiltration on myocardial performance immediately after cardiac surgery in children

A prospective randomized study

Ernesto S. Rivera, MD, FACC^*, Thomas R. Kimball, MD, FACC^*, Warren W. Bailey, MD, Sandra A. Witt, RDCS^*, Philip R. Khoury, MS^* and Stephen R. Daniels, MD, PhD^*

^* Non-Invasive Cardiac Imaging and Hemodynamic and Research Laboratory, Division of Cardiology, Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Division of Cardiothoracic Surgery, Children’s Hospital Medical Center, Cincinnati, Ohio, USA

Manuscript received January 10, 1997; revised manuscript received May 4, 1998, accepted May 15, 1998.

Address for correspondence: Dr. Thomas R. Kimball, Division of Cardiology, Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229
Kimbt0{at}chmcc.org

Objectives. This study sought to evaluate the effects of veno-venous ultrafiltration on myocardial contractility in children undergoing cardiopulmonary bypass (CPB) for repair of congenital heart defects.

Background. Ultrafiltration (UF) is currently used to diminish postoperative fluid accumulation following CPB in children. Previous reports indicate improvement in hemodynamics immediately after UF, but the mechanism of its action is unknown.

Methods. Twenty-three patients (ages 2 months to 9.1 years; 13 males, 10 females) underwent UF for 10 min after CPB. Twelve patients underwent UF immediately after CPB (Group A). They were studied: (1) before and (2) after CPB, (3) after UF, and (4) 10 min after UF. Eleven patients underwent UF 10 min after CPB (Group B). They were studied: (1) before and (2) after CPB, (3) after a 10-min delay before UF, and (4) after UF. Contractility was determined by the difference in the observed and predicted velocity of circumferential fiber shortening for the measured wall stress, using transesophageal echocardiography. Left ventricular wall thickness was also measured.

Results. There was significant improvement in contractility after UF in both groups (mean ± SD, Group A: –0.28 ± 0.13 to –0.01 ± 0.21 circ/s, p < 0.05; Group B: –0.26 ± 0.16 to –0.11 ± 0.17 circ/s, p < 0.05). Myocardial thickness to cavity dimension decreased in both groups following UF (Group A: 0.19 ± 0.04 to 0.14 ± 0.03, p < 0.05; Group B: 0.18 ± 0.04 to 0.14 ± 0.03, p < 0.05).

Conclusions. UF improves hemodynamics by improving contractility and possibly by reducing myocardial edema in children following cardiac surgery. Enhanced patient outcome after ultrafiltration may in part be due to these changes.

Abbreviations and Acronyms   BP = blood pressure   CPB = cardiopulmonary bypass   FS = end-systolic fiber stress   hd = LV wall thickness at end-diastole   hes = LV wall thickness at end-systole   LV = left ventricle   LVED = left ventricular end diastolic dimension   SF = shortening fraction   TEE = transesophageal echocardiography   UF = ultrafiltration   VCFc = heart-rate corrected velocity of circumferential fiber shortening   WS = end-systolic wall stress

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