Comparison of conventional and modified ultrafiltration on perioperative clinical outcome in neonates undergoing arterial switch operation

Objective: The aim of this prospective, randomized study is to compare the effects of conventional ultrafiltration (CUF) versus combined CUF and modified ultrafiltration (MUF) in neonates undergoing an arterial switch operation (ASO) for transposition of great arteries. Methods: We conducted a prospective randomized study on 80 neonates undergoing ASO. They were randomized into two groups as follows: Group C ( n = 40) received CUF during bypass and Group M ( n = 40) received both CUF and MUF during and after the cessation of the bypass, respectively. The hemodynamic parameters, respiratory variables, hematological, inflammatory, and tissue injury parameters were compared at various time points. Results: At the post-MUF phase (T2), there was a statistically significant increase in mean arterial pressure ( P < 0.05) in Group M, and the vasoactive inotrope score (VIS) was higher in Group C than in Group M. MUF also reduces peak airway pressure and improves the ratio of arterial oxygen tension to fraction inspired oxygen (PaO 2 /FiO 2 ) compared to CUF, and this difference was statistically significant ( P < 0.05). MUF resulted in a significant increase in hemoglobin (Hb) and platelet levels and significantly reduced the chest tube output and transfused blood and blood products. The mean values of interleukin-6, C-reactive protein, and lactate dehydrogenase between the two groups did not show any significant difference postsurgery. No statistically significant difference was observed in the duration of postoperative mechanical ventilation time and length of intensive care unit (ICU) stay between the two groups. Conclusions: Administration of MUF following surgery leads to an increase in Hb and platelet levels, reduces blood transfusion requirement, and decreases chest tube output postoperatively. It improves the hemodynamic status of patients and requires less inotropic support. We also found that MUF does not affect the duration of mechanical ventilation time, ICU stay, or outcome, despite improvements in hemodynamics and pulmonary function.