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Modified ultrafiltration & postoperative course in patients undergoing repair of Tetralogy of Fallot
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  • Sachin Talwar,
  • Neralakere Sujith,
  • Palleti Rajashekar,
  • Neeti Makhija,
  • Vishnubhatla Sreenivas,
  • Ashish Upadhaya,
  • Manoj Kumar Sahu,
  • Shiv Choudhary
Sachin Talwar
All India Institute of Medical Sciences
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Neralakere Sujith
All India Institute of Medical Sciences
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Palleti Rajashekar
All India Institute of Medical Sciences, Cardiothoracic & Vascular Surgery New Delhi, India
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Neeti Makhija
All India Institute of Medical Sciences
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Vishnubhatla Sreenivas
All India Institute of Medical Sciences
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Ashish Upadhaya
All India Institute of Medical Sciences
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Manoj Kumar Sahu
All India Inst Med Sci
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Shiv Choudhary
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Abstract

Background: Expected benefits of modified ultrafiltration(MUF) include increased hematocrit, reduction of total body water & inflammatory mediators, improved left ventricular systolic function, & improved systolic blood pressure and cardiac index following cardiopulmonary bypass(CPB). This prospective randomized trial tested this hypothesis. Methods: 79 patients undergoing intracardiac repair of Tetralogy of Fallot(TOF) were randomized to MUF group(Group-M, n=39) or only conventional ultrafiltration(CUF) group(Group-C, n=40). Primary outcome was change in hematocrit. Secondary outcomes were changes in peak airway pressures, ventilatory support, blood transfusions, time to peripheral rewarming, mean arterial pressure, central venous pressure, inotrope score(IS) and cardiac index. Serum inflammatory markers were measured. Results: Following MUF, Group-M had higher hematocrit(44.3±0.98 g/dl) compared to Group-C(37.8±1.37g/dl),P=<0.001. Central venous pressure(mmHg) immediately following sternal closure was 9.27±3.12mmHg in Group-M & 10.52±2.2mmHg in Group-C(P=0.04). In the ICU, they were 11.52±2.20mmHg in Group-C and 10.84±2.78mmHg in Group-M(P=0.02). Time to peripheral rewarming was 6.30±3.91 hours in Group-M and 13.67±3.91hours in Group-C(P=0.06). Peak airway pressures in ICU were 17±2mmHg in Group-M & 20.55±2.97mmHg in Group-C, P<0.001. Duration of mechanical ventilation was 6.3±2.7 hours in Group-M compared to 14.7±3.5 hours in Group-C(P=0.002). IS was 11.52±2.20 in Group-C compared to 10.84±2.78 in Group-M. 8/39(20.5%) patients in Group-M had IS>10 compared to 22/40(55%) patients in Group-C(P=0.02). Serum Troponin-T and Interleukin-6 levels were lower in Group-M; TNF-α and CPK-MB were similar. ICU & hospital stay were similar. Conclusion: MUF group had higher post-operative hematocrit, decreased duration of mechanical ventilation, lower need for inotropes & lower Interleukin-6 & Troponin-T levels. MUF group had better post-operative outcomes.

Peer review status:ACCEPTED

12 Nov 2020Submitted to Journal of Cardiac Surgery
13 Nov 2020Submission Checks Completed
13 Nov 2020Assigned to Editor
13 Nov 2020Reviewer(s) Assigned
03 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Dec 2020Editorial Decision: Revise Minor
06 May 20211st Revision Received
07 May 2021Assigned to Editor
07 May 2021Submission Checks Completed
08 May 2021Reviewer(s) Assigned
17 May 2021Review(s) Completed, Editorial Evaluation Pending
17 May 2021Editorial Decision: Revise Minor
08 Jun 20212nd Revision Received
08 Jun 2021Submission Checks Completed
08 Jun 2021Assigned to Editor
09 Jun 2021Reviewer(s) Assigned
15 Jun 2021Review(s) Completed, Editorial Evaluation Pending
15 Jun 2021Editorial Decision: Accept