Effects of improved ultrafiltration on serum level of IL-6 and TNF-a, HCT, and cardiopulmonary function in patients with extracorporeal circulation in valve replacement.

BACKGROUND: To investigate the effects of modified ultrafiltration in extracorporeal circulation valve replacement surgery. METHODS: A total of 62 patients with valvular disease who underwent valve replacement were included. They were randomly divided into the conventional ultrafiltration group (CUF group, n=31) and the modified ultrafiltration group (MUF group, n=31). The hematocrit (Hct) values, volume of pleural fluid drainage at 24 hours after operation, Intensive Care Unit (ICU) stay time, postoperative 24-hour blood loss, bank blood usage, postoperative 24-hour urine volume, ventilator support time, cardiac function indexes, postoperative changes of respiratory function, and levels of inflammatory factors in both groups were compared. RESULTS: After ultrafiltration, the MUF group showed higher Hct value and reduced volume of pleural fluid drainage, blood loss, bank blood usage, urine volume and ventilator support time 24 hours after operation compared with the CUF group (P<0.05). After surgery, left ventricular ejection fraction (LVEF) levels were elevated, and those in the MUF group were higher than those in the CUF group. Left ventricular end-diastolic diameter (LVEDD) and heart rate (HR) were decreased in both groups after surgery. They were lower in the MUF group than in the CUF group (P<0.05). After ultrafiltration, the OI value in the MUF group was higher, and the alveolar-arterial oxygen partial pressure gradient (P (A-a)O2) value was lower than the CUF group (P<0.05). The plasma concentrations of interleukin 6 (IL-6) and tumour necrosis factor-alpha (TNF-a) were increased after cardiopulmonary bypass (CPB) in both groups and then decreased after ultrafiltration, and IL-6 and TNF-a levels in MUF group were lower than those in CUF group (P<0.05). CONCLUSIONS: MUF attenuates the postoperative systemic inflammatory response, reduces the lung injury caused by CPB, and improves the lung function of patients in the early postoperative period, which benefits patient recovery after surgery and is valuable in heart valve replacement.