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A prospective, randomized study of the effects of continuous ultrafiltration in hepatic patients after cardiac valve surgery.

OBJECTIVES
The use of continuous ultrafiltration may be effective in preventing the hepatic decompensation in cirrhotic patients after valvular heart surgery with cardiopulmonary bypass (CPB). The authors aimed to evaluate the effects of continuous ultrafiltration on the need for blood transfusion, liver function tests, duration of postoperative ventilatory support, and the length of the intensive care unit (ICU) stay in cirrhotic patients undergoing valvular heart surgery.


DESIGN
A prospective, randomized double-blinded placebo study.


SETTING
A single university hospital.


PARTICIPANTS
Sixty cirrhotic patients scheduled for valvular surgery.


INTERVENTIONS
After local ethics committee approval and informed consent, participants were divided into 2 groups. In the conventional ultrafiltration (CUF) group (n = 30), CPB was used with conventional ultrafiltration. In the continuous ultrafiltration group (n = 30), in addition to the same CUF procedure, modified ultrafiltration was used after CPB.


MEASUREMENTS AND MAIN RESULTS
Perioperative liver function tests, hematocrit, platelet count, the postoperative ventilation time, ICU and hospital length of stay, complications, and mortality were recorded. After CPB, patients receiving continuous ultrafiltration had a shorter time to extubation, postoperative ventilation time and ICU and hospital length of stay (p < 0.01), lower bleeding (p < 0.01), greater rise in hematocrit (11.3% +/- 2.39% v 4.7% +/- 1.22%, p = 0.001) and platelet count (7.0 +/- 3.0 v 0.8 +/- 0.21 10(4)/micromL, p = 0.001), higher albumin levels (p < 0.001), and lower plasma levels of bilirubin, aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase (p < 0.02). There was no significant difference between the 2 groups in the dosage of nitroglycerin or epinephrine, morbidity, or mortality.


CONCLUSIONS
The authors concluded that continuous ultrafiltration reduced postoperative bleeding and blood transfusions, improved liver function, and shortened the hospital stay in cirrhotic patients after valvular heart surgery.