Comparison of Modified and Conventional Ultrafiltration in Pediatric Patients Undergoing Open-Heart Surgery: Single-Center, Early Outcomes

Objectives: The use of cardiopulmonary bypass (CPB) in pediatric patients during open-heart surgery is associated with excessive inflammation, fluid leakage, and end-organ dysfunction. To reduce these effects, various ultrafiltration (UF) techniques are utilized. In this study, we aimed to compare the effect and early outcomes of modified UF (MUF) and conventional UF (CUF) in infants undergoing pediatric cardiac surgery.
Methods: A total of 232 infants who underwent open-heart surgery with CPB between February 2018 and January 2020 were retrospectively reviewed. Fifty-six patients weighing ≤15 kg with a history of any UF technique use were included. Patients were stratified into CUF (n=23) and MUF (n=33) groups. Preoperative patient characteristics and intraoperative and postoperative outcomes were recorded.
Results: The MUF group had a lower patient size (height, weight, and body surface area), with no statistical difference. Intraoperative parameters (CPB and cross-clamp time) and prime solution components were similar between groups. MUF significantly shortened the mechanical ventilation (MV) time (p=0.048) in contrast to intensive care unit stay, which showed no significant difference.
Conclusion: In our series, we demonstrated that the MV duration was shorter in the MUF group, which is consistent with prior literature. Additionally, although the lower weight of the patients in the MUF group showed no statistical significance, early hemodynamic effect and low mortality in this group support the potential benefits of MUF. With its cost-efficiency and early benefits, MUF is an effective UF method with a good safety profile, especially in low-weight infants.