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Eur J Cardiothorac Surg 1999;15:742-746
© 1999 Elsevier Science NL

Modified ultrafiltration improves global left ventricular systolic function after open-heart surgery in infants and children

^a Department of Paediatric Cardiology, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, London, UK
^b Department of Cardiac Surgery, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, London, UK
^c Department of Anaesthesia, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, London, UK

Received 26 October 1998; received in revised form 15 February 1999; accepted 11 March 1999.

Corresponding author. Royal Brompton Hospital, Sydney Street, Chelsea, London SW3 6NP, UK. Tel.: +44-171-351-8546; fax: +44-171-351-8545
e-mail: reding{at}ibm.net

Objectives: Modified ultrafiltration increases blood pressure and cardiac index following open-heart surgery in children, but it is unclear if this is secondary to an improvement in global left ventricular function. A previous report has suggested that left ventricular systolic function as assessed in a single chord is improved by ultrafiltration (Davies MJ, Nguyen K, Gaynor JW, Elliott MJ. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998;115:361--370). The prominent vascular actions of modified ultrafiltration necessitate left ventricular assessment using load-independent indices of systolic and diastolic function. Methods: In 22 consecutive infants and children undergoing open-heart surgery, left ventricular function was assessed following bypass and then 10 min later. Sixteen children (median weight 8.1 kg) underwent modified ultrafiltration during this period, the remainder (median weight 7.3 kg) were controls for spontaneous recovery without ultrafiltration. Real-time pressure–volume loops, with transient inferior caval vein snaring were generated from conductance and microtip pressure catheters inserted through the LV apex. From these, load-independent (slope of the end-systolic pressure–volume [E_es] and end-diastolic pressure–volume [E_ed] relationships) and load-dependent (P_max, maximum LV pressure; P_ed, end-diastolic LV pressure; maximum [dP/dt_max] and minimum [dP/dt_min] time derivatives of LV pressure; , time constant of isovolumic relaxation) indices of left ventricular function were measured. Results: Haemoconcentration was achieved in all modified ultrafiltration patients, median increase in haematocrit 34% (interquartile range 21%, 42%), final haematocrit 0.40 (0.35, 0.41). E_es increased 58% (9, 159, P=0.005). The changes in E_ed, P_max, P_ed, dP/dt_max, dP/dt_min, and were not significantly different from the control group. Conclusion: Modified ultrafiltration improves global left ventricular systolic function in infants and children following open-heart surgery.

Key Words: Congenital heart disease • Cardiovascular surgery • Ventricular function

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