Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study

Abstract

Aim: Increased total body water and capillary permeabilty in pediatric cardiopulmonary bypass can cause organ disfunction. Modified ulltrafiltration is developed for decrease total body water and attenuate organ disfunction. The purpose of this study, is to investigate retrospective effects of modified ultrafiltration on postoperative hepatic and renal functions of pediatric patients with congenital siyanotic/nonsiyanotic heart defect who underwent open heart surgery. Material and methods: In this study, we assessed 93 children who underwent pediatric cardiac surgery with cardiopulmonary bypass from January 2009 to August 2011.Patients were divided into two groups. Group 1 (n=62) patiens, to whom modified ultrafiltration was performed, compared with 31control patients (group 2). Patients who had redo cardiac surgery, preoperative organ disfunction, otoimmune disease, genetic disorders, shunt and emergency operations were excluded. Pre and postoperative biochemical parameters, postoperative urine output, chest tube drenaige, diüretic usage, blood and blood product transfusion, dialysis requirement and mortality were compared. Results: Age, weight, body surface area, congenital defect type and number, preoperative and intraoperative blood samples measurement, cross clamp time, cardiopulmonary bypass time were similar between 2 groups (p>0,05).The difference in percent increase in creatinine leves of 2 group was statistically significant When these changes were re-evaluated according to the body surface area by univariate analysis(p<0,05). Percent increase in total plasma protein level was also statistically significant between the groups (p<0,05) (It was-6,5% in group 1 and -5,5% in group 2). Percent increase in plasma albumin level was -18,2% in group 1, and -13,4% in group 2. When these changes were re-evaluated according to the body surface area by univariate analysis, a significant statistical difference was detected. (p<0,05). While two patients required dialysis in group 1, dialysis was performed in 4 patients in group 2. There was no statistically difference between the groups in terms of dialysis needed(p<0,05). There was no difference between the groups in terms of mortality (p>0,05) Conclusion: Hemodynamic, pulmonary, hematologic and immunologic effects of modified ultrafiltration are well known. Although our study group was not big enough to get a conclusion, we believe that modified ultrafiltration can be an effective method in preservation of renal and hepatic function of the patients who underwent total reconstructive congenital heart surgery.