A comparison of effects of combined pre-bypass and conventional ultrafiltration (Pre-BUF+CUF) with conventional ultrafiltration (CUF) in pediatric and neonatal cardiac surgery in Arterial Switch Operation

Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution. However, transfusion-related inflammation affects post-CPB outcomes in neonatal open-heart surgery. Hemofiltration of the circuit prime prior to initiation of CPB helps to normalize electrolyte balance (particularly potassium, lactate and pH), increase the hematocrit level and reduce inflammatory mediators.

This prospective and randomized and controlled study was designed and the data was collected from Group A comprised of 15 patients in whom combined ultrafiltration (Pre-BUF+CUF) was performed and Group B comprised of 15 patients in whom only conventional ultratfiltration was performed.

Data were analysed between the two groups with t-test and Mann-Whitney test. In peri-operative period the potassium (4.540±5.110 meq/L) and the lactate level (1.613±4.373 mmol/L) were reduced and HCT (30.00±5.892%) level was increased significantly in Group A. In Group B the potassium (6.760±0.85434 meq/L), Lactate (3.540±0.5629 mmol/L) level were very high and HCT level (20.22±2.209%) was very low as compared to Group A. In post-operative period patients were observed in intensive care unit (ICU) for electrolyte levels, urine output, temperature, blood and blood products transfusion, inotropes administered and IVF administered in the interval of 2, 6, 12 and 24 hours were also compared between the two groups which were statistically significant in Group A (p<0.05) than Group B. Total ventilation support, mortality or discharge status and number of days of ICU stay were also compared between two groups and were found to be shorter in Group A, which is significant (p<0.05) compare to Group B. In Group A post-operative urine output (212±38.069 ml) was significantly different from Group B (153.67±22.793 ml) the temperature is also significant in Group A (36.23±0.35434.90±0.542°C) as compared to Group B (34.90±0.542°C).

We concluded from our study that the use of combined ultrafiltration can effectively concentrate blood, reduce potassium, lactate level, and increase HCT in blood prime. It reduces post-operative ventilation time, ICU stay, decreases post-operative blood transfusion, inotropes and IVF transfusion in infants undergoing corrective surgery for Transposition of Great Arteries using CPB. Hence, routine use of combined ultafiltration (Pre-BUF+CUF) is beneficial in pediatric cardiac surgery.