Estudo comparativo da ultrafiltração convencional e associação de ultrafiltração convencional e modificada na correção de cardiopatias congênitas com alto risco cirúrgico

<![CDATA[<B>Conventional ultrafiltration with technical modification in congenital heart defect surgery</B>]]>

“…Congenital heart diseases with moderate to severe pulmonary hypertension, where the ratio between pulmonary and systemic pressures is greater than or equal to 60%, prolongs the stay in the intensive care unit and the need for mechanically assisted ventilation. Surgical interventions in children who suffer from complex congenital heart diseases require longer times on CPB and lower temperatures, prolonging perfusion and ischemia times, thereby increasing the risk of water retention [1]. In both groups assessed in this study, perfusion and ischemia times were similar, reflecting the homogeneity of patient distribution in relation to the complexity of the heart diseases.…”

“…Therefore, a low hematocrit rate is more seen at lower temperatures than high ones; this can be achieved with hemodilution [14]. Considering 80 mL/kg blood volume, the initial perfusate volume was similar in both groups (102.8 mL/kg vs. 103.4 mL/kg, p-value = 0.87), remembering that the ratio between patient blood volume and perfusate volume in children is different from adults; it must always be maintained at less than 1 [1].…”

“…Ultrafiltration (UF) is a common procedure performed during cardiac surgeries with cardiopulmonary bypasses (CPB) with the aim of removing inflammatory mediators [1][2][3][4][5], as well as to reduce fluid overload [1,3] and to decrease the need for transfusions [1,6,7]. In neonates and children, systemic inflammatory response after CPB results in increased capillary permeability, which leads to increased morbidity and mortality rates [8].…”

“…In this context, UF of the perfusate is performed while the patient is still being assisted by the lung-heart machine and the hemoconcentrator is connected to the recirculation line between the oxygenator and the venous reservoir [1]. Currently a technically modified method of CUF is being used, which enables residual blood from the tube and oxygenator circuit to be used after CPB without interfering with the patient's hemodynamic performance [10].…”

<![CDATA[<b>Assessment of a new technique of hemoconcentration and the necessities of blood derivates for transfusion in patients submitted to heart surgery using cardiopulmonay bypass</b>]]>

“…In Brazil the first works about hemofiltration during CPB were experimental [11], with later clinical application [12]. The hemofiltration technique was perfected and later modified by the team of Dr. Elliot, who moved the position of the hemofilter in the CPB circuit and thus the moment of its use [13].…”