Application of combined ultrafiltration and vaccum-assisted venous drainage in extracorporeal circulation for open heart surgery in infants

Objective To summarize the managerial experiences in the application of combined ultrafiltration and vaccum-assisted venous drainage (VAVD) in extracorporeal circulation (ECC) for congenital heart diseases operation in infants. Methods The clinical data of 72 infants [42 males and 30 females, aged 14d to 24 months (13.1 ± 6.2 months), body weight 3.4-10(8.18 ± 1.88)kg], who underwent operation to correct congenital heart diseases from Jan 2011 to Dec 2012, were retrospectively analyzed. Forty-four of the 72 infants were suffering from simple congenital heart diseases (atrial or interventricular septal defect), and 28 with complicated congenital heart diseases (tetralogy of Fallot, partial/complete atrioventricular canal, double outlet of right ventricle, etc.). Membrane oxygenator (Terumo Baby-RX or Maquet VKMO 10000) was used in ECC, and the volume of priming solution (Ringer lactate solution and human serum albumin) was 250-450ml. During ECC, the perfusion flow rate was 90-150ml/ (kg.min), mean arterial pressure was maintained at 35-50mmHg, hematocrit (Hct) at 0.20-0.30, and rectal temperature at 25-32°C. Histidine-Tryptophan-Ketoglutarate (HTK) solution was used for myocardial preservation during the operation. VAVD was routinely used in ECC with negative pressure of -10 to -30mmHg. The combined ultrafiltration technique was also routinely used, i.e. conventional ultrafiltration was applied in ECC and modified ultrafiltration was applied after ECC. Results The ECC time was 30-174 (82.6 ± 31.2)min and aortic clamping time was 6-125 (51.7 ± 30.1)min. The peripheral circulation and arterial blood gas values were normal during ECC in 72 infants, and the cardiac spontaneous resuscitation rate was 94.4%(68/72 cases). The volume of conventional ultrafiltration during ECC was 60-380ml and the volume of modified ultrafiltration after ECC was 50-230ml. After the end of modified ultrafiltration, Hct was 0.32±0.11. The volume of intraoperative red blood cell (RBC) transfusion was 0.5-2.0(1.61±0.40)U, postoperative mechanic ventilator support time was 6-74(34.1±16.6)h, and the pericardial drainage volume within 24 hours was 70-410(115.6±75.8)ml. One infant suffering from complete atrioventricular canal underwent atrial septal defect repair and mitral valvuloplasty died of respiratory and circulatory failure secondary to severe postoperative low cardiac output syndrome, and the other 71 infants recovered satisfactorily, the total death rate was 1.4%(1/72). Conclusions For low-body weight infants undergoing open heart surgery, application of combined ultrafiltration and VAVD in ECC could ensure satisfactory venous drainage and minimal priming solution volume, and provide enough perfusion flow, and maintain optimal internal environment and hematocrit.