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Açık kalp cerrahisi uygulanan siyanoti/non-siyanotik konjenital kalp hastalıklarında modifiye ultrafiltrasyonun postoperatif karaciğer ve böbrek fonksiyonları üzerine etkisi: Retrsopektif çalışma

Yıl 2020, Cilt: 11 Sayı: 5, 378 - 386, 30.12.2020
https://doi.org/10.18663/tjcl.834290

Öz

Amaç: Pediatrik kardiyopulmoner baypas total vücut sıvında ve damar geçirgenliğinde artmaya neden olur. Dokular aralarına sızan bu sıvı organ fonksiyonlarında bozulmalara neden olmaktadır. Modifiye ultrafiltrasyon çocuklarda kardiyopulmoner baypasa bağlı oluşan toplam vücut sıvı artışının neden olduğu organ fonksiyon bozukluklarını önlemek amacıyla geliştirilmiştir. Bu çalışmada amacımız konjenital kalp hastalığı nedeni ile kardiyopulmoner baypas kullanılarak opere edilen siyanotik ve siyanotik olmayan çocuklarda MUF kullanımının karaciğer ve böbrek fonksiyonları üzerine etkisiniaraştırmaktı.
Gereç ve Yöntemler: Ocak 2009 ile ağustos 2011 yılları arasında Ankara Üniversitesi Tıp Fakültesi Kalp ve damar cerrahisi kliniğinde opere edilen modifiye ultrafiltrasyon kullanılan (grup 1) n:63, kullanılmayan (grup 2) n:31 toplam 93 hasta çalışmaya dahil edildi. Daha önceden bilinen operasyon ve organ fonksiyon bozukluğu olan, acil şartlarda operasyona alınan, sistemik ve otoimmün hastalığı olan ve kompleks kardiyak anomali nedeni ile parsiyel düzeltme yapılan hastalar çalışmaya dahil edilmedi. Organ fonksiyonlarının değerlendirilmesi amacıyla operasyon öncesinde ve sonrasında kan örnekleri alındı. Hastalar operasyon sonrası ilk 8 ve 24.saat idrar miktarı, drenaj miktarı, diüretik kullanımı, inotrop kullanımı, kan ve kan ürünü kullanımı, diyaliz ihtiyacı ve mortalite açısından retrospektif olarak incelendi.
Bulgular: Preoperatif verileri ve operasyon verileri açısından gruplar benzerdi. Grup 1 için kreatinin düzeyinin operasyon sonrasında yüzde değişim oranı %56,5, grup 2 için %25,8 olarak hesaplandı. Vücut yüzey alanına göre univaryant analizde anlamlı olarak bulundu. (p:0,031<0,05) Total protein değerlerinin operasyon sonrası değişim yüzdesi (-)%6,5, grup 2 için (-)%5,5 olarak hesaplandı. Bu sonuçlar istatistiksel olarak anlamlı bulundu. (p:0,04<0,05) Albümin düzeylerindeki yüzde değişim oranı açısından grup1 (-)%18,2, grup 2 için (-)%13,4 olarak hesaplandı. Bu değişimler vücut yüzey alanına göre yeniden univaryant analiz ile değerlendirildiğinde anlamlı istatsitiksel fark saptandı (p=0,05). Grup 1 için dializ ihtiyacı olan hasta sayısı 2, Grup 2 için 4 hasta olarak bulundu. Bu sonuç istatistiksel olarak anlamlı bulundu (p=0,05). Mortalite grup1 için 4 hasta, grup 2 için 1 hasta olarak bulundu. Mortalite açısından gruplar arasında anlamlı istatistiksel fark hesaplanmadı (p>0,05).
Sonuç: Pediatrik açık kalp cerrahisinde modifiye ultrafiltrasyonun kullanımının böbrek yetmezliği gelişimini azalttığı ve karaciğer fonksiyonlarını koruduğunu düşünmekteyiz.

Kaynakça

  • 1. Naik SK, Knight A, Elliott M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991; 84: 422-31.
  • 2. Krispinsky LT, Stark RJ, Parra DA et al. Endothelial-dependent vasomotor dysfunction in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2020; 21: 42-9
  • 3. Ziyaeifard M, Alizadehasl A, Aghdaii N et al. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. J Res Med Sci. 2016; 21: 133.
  • 4. Milovanovic V, Bisenic D, Mimic B et al. Reevaluating the Importance of Modified Ultrafiltration in Contemporary Pediatric Cardiac Surgery. J Clin Med 2018; 7:498.
  • 5. Zakkar M, Guida G, Angelini GD. Modified ultrafiltration in adult patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2015; 20: 415-21.
  • 6. Raja SG, Yousufuddin S, Rasool F, Nubi A, Danton M, Pollock J. Impact of modified ultrafiltration on morbidity after pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 2006; 14: 341-50.
  • 7. Williams GD, Ramamoorthy C, Chu L, et al. Modified and conventional ultrafiltration during pediatric cardiac surgery: Clinical outcomes compared. J Thorac Cardiovasc Surg 2006; 132: 1291-8.
  • 8. Shann KG, Giacomuzzi CR, Harness L et al. Complications relating to perfusion and extracorporeal circulation associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young. 2008; 18: 206-14.
  • 9. Chew MS, Brix-Christensen V, Ravn HB et al. Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: A prospective, randomized study. Perfusion 2002; 17: 327-33.
  • 10. Timpa JG, O’Meara LC, Goldberg KG et al. Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product utilization and improves some bleeding outcomes. J Extra Corpor Technol 2016; 48: 11-8.
  • 11. Gaynor JW. Use of Modified Ultrafiltration After Repair of Congenital Heart Defects. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998; 1: 81-90.
  • 12. Lang SM, Syed MA, Dziura J et al. The effect of modified ultrafiltration on angiopoietins in pediatric cardiothoracic operations. Ann Thorac Surg 2014; 98: 1699-704.
  • 13. Hiramatsu T, Imai Y, Kurosawa H et al. Effects of dilutional and modified ultrafiltration in plasma endothelin-1 and pulmonary vascular resistance after the Fontan procedure. Ann Thorac Surg 2002; 73: 861-5.
  • 14. Wang W, Huang HM, Zhu DM, Chen H, Su ZK, Ding WX. Modified ultrafiltration in paediatric cardiopulmonary bypass. Perfusion 1998; 13: 304-10.
  • 15. Pearl JM, Manning PB, McNamara JL, Saucier MM, Thomas DW. Effect of modified ultrafiltration on plasma thromboxane B2, leukotriene B4, and endothelin-1 in infants undergoing cardiopulmonary bypass. Annals of Thoracic Surgery 1999; 68: 1369-75.
  • 16. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 2019; 60: 3-11.
  • 17. Li J, Hoschtitzky A, Allen ML, Elliott MJ, Redington AN. An analysis of oxygen consumption and oxygen delivery in euthermic infants after cardiopulmonary bypass with modified ultrafiltration. Ann Thorac Surg 2004; 78: 1389-96.
  • 18. Wang MJ, Chiu IS, Hsu CM et al. Efficacy of ultrafiltration in removing inflammatory mediators during pediatric cardiac operations. Ann Thorac Surg 1996; 61: 651-6.
  • 19. Elliott MJ. Ultrafiltration and modified ultrafiltration in pediatric open heart operations. Ann Thorac Surg 1993; 56: 1518-22.
  • 20. Davies MJ, Nguyen K, Gaynor JW et al. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 115: 361-9.
  • 21. Türköz A, Tunçay E, Balci ŞT et al. The effect of modified ultrafiltration duration on pulmonary functions and hemodynamics in newborns and infants following arterial switch operation. Pediatr Crit Care Med 2014; 15: 600-7.
  • 22. Ziyaeifard M, Alizadehasl A, Massoumi G. Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med 2014; 3: 17830.
  • 23. Mauermann WJ, Nuttall GA, Cook DJ, Hanson AC, Schroeder DR, Oliver WC. Hemofiltration during cardiopulmonary bypass does not decrease the incidence of atrial fibrillation after cardiac surgery. Anesth Analg 2010; 110: 329-34.
  • 24. Ricci Z, Polito A, Netto R et al. Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery. Pediatr Crit Care Med 2013; 14: 390-5.
  • 25. Hodges UM, Berg S, Naik SK, Bower S, Lloyd-Thomas A, Elliot M. Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children. J Cardiothorac Vasc Anesth 1994; 8: 653-7.
  • 26. Kuratani N, Bunsangjaroen P, Srimueang T, Masaki E, Suzuki T, Katogi T. Modified versus conventional ultrafiltration in pediatric cardiac surgery: A meta-analysis of randomized controlled trials comparing clinical outcome parameters. J Thorac Cardiovasc Surg 2011; 142: 861-7.
  • 27. Journois D, Israel-Biet D, Pouard P et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology 1996; 85: 965-76.
  • 28. Ootaki Y, Yamaguchi M, Oshima Y, Yoshimura N, Oka S. Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery. Surg Today 2002; 32: 203-6.
  • 29. Andreasson S, Göthberg S, Berggren H, Bengtsson A, Eriksson E, Risberg B. Hemofiltration modifies complement activation after extracorporeal circulation in infants. Ann Thorac Surg 1993; 56: 1515-7.

Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study

Yıl 2020, Cilt: 11 Sayı: 5, 378 - 386, 30.12.2020
https://doi.org/10.18663/tjcl.834290

Öz

Aim: Increased total body water and capillary permeabilty in pediatric cardiopulmonary bypass can cause organ disfunction. Modified ulltrafiltration is developed for decrease total body water and attenuate organ disfunction. The purpose of this study, is to investigate retrospective effects of modified ultrafiltration on postoperative hepatic and renal functions of pediatric patients with congenital siyanotic/nonsiyanotic heart defect who underwent open heart surgery.
Material and methods: In this study, we assessed 93 children who underwent pediatric cardiac surgery with cardiopulmonary bypass from January 2009 to August 2011.Patients were divided into two groups. Group 1 (n=62) patiens, to whom modified ultrafiltration was performed, compared with 31control patients (group 2). Patients who had redo cardiac surgery, preoperative organ disfunction, otoimmune disease, genetic disorders, shunt and emergency operations were excluded. Pre and postoperative biochemical parameters, postoperative urine output, chest tube drenaige, diüretic usage, blood and blood product transfusion, dialysis requirement and mortality were compared.
Results: Age, weight, body surface area, congenital defect type and number, preoperative and intraoperative blood samples measurement, cross clamp time, cardiopulmonary bypass time were similar between 2 groups (p>0,05).The difference in percent increase in creatinine leves of 2 group was statistically significant When these changes were re-evaluated according to the body surface area by univariate analysis(p<0,05). Percent increase in total plasma protein level was also statistically significant between the groups (p<0,05) (It was-6,5% in group 1 and -5,5% in group 2). Percent increase in plasma albumin level was -18,2% in group 1, and -13,4% in group 2. When these changes were re-evaluated according to the body surface area by univariate analysis, a significant statistical difference was detected. (p<0,05). While two patients required dialysis in group 1, dialysis was performed in 4 patients in group 2. There was no statistically difference between the groups in terms of dialysis needed(p<0,05). There was no difference between the groups in terms of mortality (p>0,05)
Conclusion: Hemodynamic, pulmonary, hematologic and immunologic effects of modified ultrafiltration are well known. Although our study group was not big enough to get a conclusion, we believe that modified ultrafiltration can be an effective method in preservation of renal and hepatic function of the patients who underwent total reconstructive congenital heart surgery.

Kaynakça

  • 1. Naik SK, Knight A, Elliott M. A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991; 84: 422-31.
  • 2. Krispinsky LT, Stark RJ, Parra DA et al. Endothelial-dependent vasomotor dysfunction in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2020; 21: 42-9
  • 3. Ziyaeifard M, Alizadehasl A, Aghdaii N et al. The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. J Res Med Sci. 2016; 21: 133.
  • 4. Milovanovic V, Bisenic D, Mimic B et al. Reevaluating the Importance of Modified Ultrafiltration in Contemporary Pediatric Cardiac Surgery. J Clin Med 2018; 7:498.
  • 5. Zakkar M, Guida G, Angelini GD. Modified ultrafiltration in adult patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2015; 20: 415-21.
  • 6. Raja SG, Yousufuddin S, Rasool F, Nubi A, Danton M, Pollock J. Impact of modified ultrafiltration on morbidity after pediatric cardiac surgery. Asian Cardiovasc Thorac Ann 2006; 14: 341-50.
  • 7. Williams GD, Ramamoorthy C, Chu L, et al. Modified and conventional ultrafiltration during pediatric cardiac surgery: Clinical outcomes compared. J Thorac Cardiovasc Surg 2006; 132: 1291-8.
  • 8. Shann KG, Giacomuzzi CR, Harness L et al. Complications relating to perfusion and extracorporeal circulation associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young. 2008; 18: 206-14.
  • 9. Chew MS, Brix-Christensen V, Ravn HB et al. Effect of modified ultrafiltration on the inflammatory response in paediatric open-heart surgery: A prospective, randomized study. Perfusion 2002; 17: 327-33.
  • 10. Timpa JG, O’Meara LC, Goldberg KG et al. Implementation of a multidisciplinary bleeding and transfusion protocol significantly decreases perioperative blood product utilization and improves some bleeding outcomes. J Extra Corpor Technol 2016; 48: 11-8.
  • 11. Gaynor JW. Use of Modified Ultrafiltration After Repair of Congenital Heart Defects. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998; 1: 81-90.
  • 12. Lang SM, Syed MA, Dziura J et al. The effect of modified ultrafiltration on angiopoietins in pediatric cardiothoracic operations. Ann Thorac Surg 2014; 98: 1699-704.
  • 13. Hiramatsu T, Imai Y, Kurosawa H et al. Effects of dilutional and modified ultrafiltration in plasma endothelin-1 and pulmonary vascular resistance after the Fontan procedure. Ann Thorac Surg 2002; 73: 861-5.
  • 14. Wang W, Huang HM, Zhu DM, Chen H, Su ZK, Ding WX. Modified ultrafiltration in paediatric cardiopulmonary bypass. Perfusion 1998; 13: 304-10.
  • 15. Pearl JM, Manning PB, McNamara JL, Saucier MM, Thomas DW. Effect of modified ultrafiltration on plasma thromboxane B2, leukotriene B4, and endothelin-1 in infants undergoing cardiopulmonary bypass. Annals of Thoracic Surgery 1999; 68: 1369-75.
  • 16. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 2019; 60: 3-11.
  • 17. Li J, Hoschtitzky A, Allen ML, Elliott MJ, Redington AN. An analysis of oxygen consumption and oxygen delivery in euthermic infants after cardiopulmonary bypass with modified ultrafiltration. Ann Thorac Surg 2004; 78: 1389-96.
  • 18. Wang MJ, Chiu IS, Hsu CM et al. Efficacy of ultrafiltration in removing inflammatory mediators during pediatric cardiac operations. Ann Thorac Surg 1996; 61: 651-6.
  • 19. Elliott MJ. Ultrafiltration and modified ultrafiltration in pediatric open heart operations. Ann Thorac Surg 1993; 56: 1518-22.
  • 20. Davies MJ, Nguyen K, Gaynor JW et al. Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 115: 361-9.
  • 21. Türköz A, Tunçay E, Balci ŞT et al. The effect of modified ultrafiltration duration on pulmonary functions and hemodynamics in newborns and infants following arterial switch operation. Pediatr Crit Care Med 2014; 15: 600-7.
  • 22. Ziyaeifard M, Alizadehasl A, Massoumi G. Modified ultrafiltration during cardiopulmonary bypass and postoperative course of pediatric cardiac surgery. Res Cardiovasc Med 2014; 3: 17830.
  • 23. Mauermann WJ, Nuttall GA, Cook DJ, Hanson AC, Schroeder DR, Oliver WC. Hemofiltration during cardiopulmonary bypass does not decrease the incidence of atrial fibrillation after cardiac surgery. Anesth Analg 2010; 110: 329-34.
  • 24. Ricci Z, Polito A, Netto R et al. Assessment of modified ultrafiltration hemodynamic impact by pressure recording analytical method during pediatric cardiac surgery. Pediatr Crit Care Med 2013; 14: 390-5.
  • 25. Hodges UM, Berg S, Naik SK, Bower S, Lloyd-Thomas A, Elliot M. Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children. J Cardiothorac Vasc Anesth 1994; 8: 653-7.
  • 26. Kuratani N, Bunsangjaroen P, Srimueang T, Masaki E, Suzuki T, Katogi T. Modified versus conventional ultrafiltration in pediatric cardiac surgery: A meta-analysis of randomized controlled trials comparing clinical outcome parameters. J Thorac Cardiovasc Surg 2011; 142: 861-7.
  • 27. Journois D, Israel-Biet D, Pouard P et al. High-volume, zero-balanced hemofiltration to reduce delayed inflammatory response to cardiopulmonary bypass in children. Anesthesiology 1996; 85: 965-76.
  • 28. Ootaki Y, Yamaguchi M, Oshima Y, Yoshimura N, Oka S. Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery. Surg Today 2002; 32: 203-6.
  • 29. Andreasson S, Göthberg S, Berggren H, Bengtsson A, Eriksson E, Risberg B. Hemofiltration modifies complement activation after extracorporeal circulation in infants. Ann Thorac Surg 1993; 56: 1515-7.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Deniz Bozdogan Bu kişi benim

Mustafa Şırlak

Zeynep Eyıleten

Adnan Uysalel

Yayımlanma Tarihi 30 Aralık 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 11 Sayı: 5

Kaynak Göster

APA Bozdogan, D., Şırlak, M., Eyıleten, Z., Uysalel, A. (2020). Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study. Turkish Journal of Clinics and Laboratory, 11(5), 378-386. https://doi.org/10.18663/tjcl.834290
AMA Bozdogan D, Şırlak M, Eyıleten Z, Uysalel A. Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study. TJCL. Aralık 2020;11(5):378-386. doi:10.18663/tjcl.834290
Chicago Bozdogan, Deniz, Mustafa Şırlak, Zeynep Eyıleten, ve Adnan Uysalel. “Effects of Modified Ultrafiltration on Postoperative Hepatic and Renal Function of Pediatric Patients With Congenital cyanotic/Non-Cyanotic Heart Defect Who Underwent Open Heart Surgery: Retrospective Study”. Turkish Journal of Clinics and Laboratory 11, sy. 5 (Aralık 2020): 378-86. https://doi.org/10.18663/tjcl.834290.
EndNote Bozdogan D, Şırlak M, Eyıleten Z, Uysalel A (01 Aralık 2020) Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study. Turkish Journal of Clinics and Laboratory 11 5 378–386.
IEEE D. Bozdogan, M. Şırlak, Z. Eyıleten, ve A. Uysalel, “Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study”, TJCL, c. 11, sy. 5, ss. 378–386, 2020, doi: 10.18663/tjcl.834290.
ISNAD Bozdogan, Deniz vd. “Effects of Modified Ultrafiltration on Postoperative Hepatic and Renal Function of Pediatric Patients With Congenital cyanotic/Non-Cyanotic Heart Defect Who Underwent Open Heart Surgery: Retrospective Study”. Turkish Journal of Clinics and Laboratory 11/5 (Aralık 2020), 378-386. https://doi.org/10.18663/tjcl.834290.
JAMA Bozdogan D, Şırlak M, Eyıleten Z, Uysalel A. Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study. TJCL. 2020;11:378–386.
MLA Bozdogan, Deniz vd. “Effects of Modified Ultrafiltration on Postoperative Hepatic and Renal Function of Pediatric Patients With Congenital cyanotic/Non-Cyanotic Heart Defect Who Underwent Open Heart Surgery: Retrospective Study”. Turkish Journal of Clinics and Laboratory, c. 11, sy. 5, 2020, ss. 378-86, doi:10.18663/tjcl.834290.
Vancouver Bozdogan D, Şırlak M, Eyıleten Z, Uysalel A. Effects of modified ultrafiltration on postoperative hepatic and renal function of pediatric patients with congenital cyanotic/non-cyanotic heart defect who underwent open heart surgery: Retrospective study. TJCL. 2020;11(5):378-86.


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