A high-efficiency MUF method benefits postoperative hemodynamic stability and oxygen delivery in neonates with transposition of great arteries.

Abstract

To minimize the postoperative hemodynamic changes in neonates with transposition of great arteries (TGA) by modifying the circuit and efficiency of traditional modified ultrafiltration (MUF). Ninety-one patients (<5 kg) underwent arterial switch operations, which were randomized to a traditional MUF (tMUF) group (N = 38) or a modified MUF (mMUF) group (N = 53). MUF of both the groups lasted for 8 to 12 minutes, during which the near-infrared spectroscopy was used to monitor cerebral tissue oxygenation parameters. The cerebral oxygenation was significantly improved after MUF in both groups. The tissue hemoglobin concentration index (THI) was proportional to the total cerebral hemoglobin during MUF. The ascending velocity of THI was faster in the mMUF group. The mean change range in the mMUF group was 0.90 ± 0.44 mM/cm, while that in the tMUF group was 0.51 ± 0.35 mM/cm (P = 0.028). Quantitative changes in the cerebral concentration of oxygenated hemoglobin increased faster in the mMUF group, in which a nadir of low efficacy MUF was not observed. The rising velocity of the tissue oxygenation index was faster in the mMUF group. All mMUF cases had stable hemodynamics during MUF. The tMUF was aborted in two patients because of unstable hemodynamics. At the end of MUF, hematocrit was significantly greater in the mMUF group than in the tMUF group (40.33 ± 5.43% vs 34.41 ± 5.11%; P < 0.01) CONCLUSION: The mMUF circuit is more miniaturized and less prime, which leads to more efficient ultrafiltration. It benefits postoperative hemodynamic stability and oxygen delivery in neonates with TGA.