Efficacy of haemofiltration during cardiopulmonary bypass in paediatric open heart surgery P Saxena, MD, N Saxena, MD, R Sharma, M.Ch. Cardiothoracic Centre, AIIMS, New Delhi Abstract Purpose.: Haemofiltration is a useful method for removing fluid overload in paediatric patients undergoing open heart surgery. However, its role in reducing the inflammatory response to cardiopulmonary bypass (CPB) is still controversial. This study was undertaken to examine the efficacy of haemofilter in reducing the inflammatory response to CPB in paediatric patients undergoing open heart surgery. Methods. We studied 20 paediatric patients undergoing open heart surgery with long duration CPB. In ten patients conventional methods of suppressing inflammation, like aprotinin and methylprednisolone were used and in the other ten patients, haemofiltration was added to the conventional methods. Inflammatory response was assessed by increase in total white blood cell counts and decrease in complement factor 3 (C3) levels. Patients were followed up in the intensive care unit. Result. The fall in C3 concentration and increase in WBC counts was significantly more in conventional group (29.1% and 81% respectively) as compared to the haemofilter group (11.4% and 37% respectively). However, it did not reflect on any significant increase in postoperative PaO2, decrease in mechanical ventilation or ICU stay. Conclusion. Use of haemofilter decreases the inflammatory response, but its clinical implication in postoperative period is still not clear. (Ind J Thorac Cardiovasc Surg, 2001; 17: 73-76) Key words. Complement, haemofilter, inflammatory response, cardiopulmonary bypass. Introduction The advancements in cardiopulmonary bypass (CPB) have made cardiac surgery for congenital heart disease a safe procedure. The systemic inflammatory response syndrome (SIRS), also called post perfusion syndrome, is a well known phenomenon. ~ Infants are more vulnerable to the damaging effects of CPB than adults. 2,3 This damage is due to cellular activation, complement activation and release of inflammatory mediators. 4,5 Consumption of C3, C4 and other factors intraoperatively is an indication of complement activation. 6 The immature kidneys of the newborn are particularly susceptible to long CPB duration and deep Address for Correspondence Dr. Pravin Saxena, MD Assistant Professor Department of Cardiac Anaesthesia Cardiothoracic Centre AIIMS, New Delhi - 110 029 Email : psaxena@medinst.ernet.in @IJTCVS 097091341720601/004 hypothermic conditions used in paediatric open heart surgery 7and result in postoperative fluid overload, renal failure and morbidity. 5 Haemofiltration is a useful method for reduction of this fluid overload and renal failure in infants after CPB. 8,9 But the positive effects are not only because of decreasing hyperhydration but also due to enhanced clearance of mediators of inflammation. 2 However, its exact role, including its efficiency and safety is still under investigation. 1~ This study was undertaken to determine whether haemofiltration reduces the inflammatory response to long CPB in paediatric patients undergoing open heart surgery. Patients and Methods Twenty children (age < 5 years) undergoing surgery for complex congenital heart disease were studied prospectively. Patients with preoperative renal problem or on steroid therapy were excluded from the study. Patients with postoperative sepsis or who expired in immediate postoperative period were also excluded.