Modified Ultrafiltration in Coronary Artery Bypass Grafting: A Randomized, Double-Blinded, Controlled Clinical Trial Publisher



Tabaei AS¹ ; Mortazian M² ; Yaghoubi A¹ ; Gorjipour F¹ ; Manesh SA³ ; Totonchi Z¹ ; Baharestani B¹ ; Mehrabanian M⁴ ; Pazokitoroudi H⁵ ; Kaveh H¹ ; Toloueitabar Y¹ ; Ghanbari A¹ ; Gorjipour F¹ Show Affiliations
Source: Iranian Red Crescent Medical Journal Published:2018

Abstract

Background: Modified Ultrafiltration (MUF) has been used in Cardiopulmonary Bypass (CPB) operations to prevent hemodilution and remove pro-inflammatory cytokines. It has been studied in pediatric operation settings. However, evidence exists regarding its application in adults’ Coronary Artery Bypass Grafting (CABG) operation. Objectives: The present study investigated MUF and its effects on inflammatory cytokine response, hemodilution and rotational thromboelastometry outcomes in adults’ CABG operation. Methods: In a randomized controlled trial, 56 elective CABG patients that had referred to the Rajaie Cardiovascular Medical and Research Center (Tehran, Iran) during year 2017 were randomly assigned to two groups, including control and MUF groups. Preoperative and postoperative clinical parameters were recorded. Serum level of inflammatory cytokines after clamp removal, after Cardiopulmonary Bypass (CPB) (MUF in the MUF group) and 24 hours after Intensive Care Unit (ICU) entrance, and Rotational Thrombo-elastometry (ROTEM) indices, pre-operation, and post-operation, were measured. Results: The two groups were similar in clinical perioperative parameters, including hemodynamics, transfusions, ROTEM indices, mechanical ventilation and CPB time, and ICU stay. The levels of inflammatory mediators were significantly increased after CPB in both groups. Interleukin (IL)-6,-8 and-10 measures were equal between the two groups in all trial measurement points. The MUF group demonstrated a significantly lower level of Tumor Necrosis Factor (TNF)-α compared with the control group after CPB (1.55 ± 0.29 versus 1.77 ± 0.35 log10 pg/mL, respectively; P = 0.031). Hemoglobin (9.55 ± 0.96 versus 8.29 ± 0.57 g/dl, P < 0.001) and hematocrit % (29.96 ± 3.23 and 24.72 ± 1.62, P < 0.001) levels were significantly higher in the MUF group compared with the control, after CPB. Conclusions: Modified Ultrafiltration eliminates extra liquids and TNF-α from circulation in adults CABG operation, without affecting the hemostatic indices and improves hemoglobin level. It does not remove anti-inflammatory cytokine IL-10 from circulation. © 2018, Author(s).