Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery

Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB). Methods Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group,conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group,cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (C stat ),airway resistance (R aw ),alveolar-arterial oxygen difference (A-a DO 2),hematocrit (HCT),serum albumin (Alb),interleukin-6 (IL-6),endothelia-1 (ET-1) and thromboxane (TXB 2) were measured. Results The pulmonary function was improved,HCT and serum albumin concentrations were increased,and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.Conclusions Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood,exclude harmful inflammatory mediators,and attenuate lung edema and inflammatory responsive pulmonary injury.

Off-Pump Complete Coronary Revascularization with 860 cases andtwo year experience

Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary artery bypass grafting is becoming increasingly popular world wide. We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB. Methods From Aug 1998 to Aug 2000, 860 off pump revascularizations (99%since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%). Averaged age 64.2±15 years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off pump CABG patients. Single graft 72 (8.3%), two grafts 208 (24.2%), three grafts 469 (54.5%), four grafts 101 (11.8%), five graft 10 (1.2%). The average number of grafts per patient was 2.72±0.32. Operative mortality was 0.69%(6 patients). Anesthetic time 3.9±1.2hours, extubation time 6±2.5 hours, Blood requirement 360±90 ml, Preoperative LVEF 60.2±8.5%, Post LVEF 64.1±14%Low cardiac output 48 patients (5.6%), IABP requirement: 25 patients(2.9%), 25 patients converted to CPB during OP CAB(2.9%)and 20 of them were done with on pump beating heart. 25 patients showed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1.1±0.8 days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revascularization is a safe, effective technique and suitable.