Brazilian Journal of Cardiovascular Surgery (Jul 1999)
Estudo comparativo da ultrafiltração convencional e associação de ultrafiltração convencional e modificada na correção de cardiopatias congênitas com alto risco cirúrgico Comparative study of standard ultrafiltration and its association with modification for the correction of high surgical risk congenital heart diseases
Abstract
A necessidade de correção cirúrgica de má-formações cardíacas complexas, que requerem tempos prolongados de circulação extracorpórea (CEC) aumentou a morbimortalidade devido a retenção hídrica e reação inflamatória sistêmica. O objetivo deste estudo é comparar a evolução pós-operatória imediata de pacientes submetidos a ultrafiltração convencional (UFC) durante a CEC e ultrafiltração modificada (UFM) após CEC. Quarenta e um pacientes submetidos a correção cirúrgica de cardiopatias congênitas foram divididos em 2 grupos: G1: 21 pacientes com idade de 15 dias a 36 meses (mediana: 11 meses) e peso de 3,6 a 13,5 kg (M: 7,27 ± 3,07), operados entre 1996 e 1997, foram submetidos a UFC. G2: 20 pacientes com idade de 9 dias a 36 meses (mediana: 5,5 meses) e peso entre 2,2 e 12 kg (M: 5,7 ± 2,5), operados entre 1997 e 1998, foram submetidos a UFC+UFM. Dentre as operações mais freqüentes temos: ventriculosseptoplastia, 15 (36,5%) casos; operação de Jatene, 10 (24,3% ) casos; correção de defeito septal A-V total, 7 (17,0%) casos etc. A análise estatística de idade, peso e complexidade cirúrgica mostrou semelhança entre os grupos. Houve 6 (28,5%) óbitos no G1 e 4 (20%) no G2, (p=0,71). O volume médio ultrafiltrado no G1 (UFC) foi 143,3 ml e no G2 (UFC+UFM) foi 227,0 ml, (pSurgical correction of complex cardiac malformations that require extended extracorporeal circulation (ECC) increase morbidity/mortality due to water retention and systemic inflammatory reaction. The purpose of this study is to compare the immediate postoperative evolution of patients submitted to conventional ultrafiltration (CUF) during ECC and modified ultrafiltration (MUF) after ECC. Forty-one patients submitted to surgical correction of congenital cardiac disease were divided into 2 groups: G1 - 21 patients with ages from 15 days to 36 months (median 11 months) and weighing from 3.6 kg (M: 7.27 ± 3.07), operated on between 1996 and 1997 were submitted to CUF; G2 - 20 patients with ages ranging from 9 days to 36 months (median 5.5) and weighing from 2.2 to 12 kg (M: 5.7±2.5) operated on between 1997 and 1998 were submitted to CUF + MUF. Among the most frequent surgeries were: ventriculoseptoplasty, 15 (36.58) cases; Jatene's surgery, 10 (24.38) cases; correction of septal A-V defect, 7 (17.08) cases, etc. Statistical analysis regarding age, weight and surgical complexity showed similarity between the groups. There were 6 (28.58) deaths in G1 and 4 (20.08) in G2, p= 0.71. The mean ultrafiltered volume in G1 (CUF) was 143.3 ml and 227.0 ml in G2 (CUF+MUF) p<0.001, showing a statistically significant difference. However, the mean time of mechanical ventilation (G1: 94.8 h and G2: 95.6 h, p= 0.97), mean time of inotropic drug use (G1: 145.2 h and G2: 137.6 h, p=0.85), mean time stay in Intensive Care Unit (G1: 169.6 h and G2: 157.8 h, p= 0.79) and mean time of hospital stay (G1: 14.8 d and G2: 14.6 d, p= 0.95) did not show significant differences between the groups. The CUF technique used for more than 8 years on our Service showed similar results when compared with the CUF + MUF association. MUF was efficient regarding removal of body water after ECC without intercurrent episodes due to the method. Possibly a randomized study on a greater number of patients would allow to detect differences between the two methods.
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