The Use of Ultrafiltration in High-Risk Post-operative Coronary Artery
Bypass Grafting Patients.
Abstract
Abstract: Background: Fluid overload (FO) and acute
kidney injury (AKI) after CABG surgery are due to multiple perioperative
etiologies associated with high failure to rescue rates (FTR) and
associated with poor outcomes 1-,3. Diuretics, fluid
restriction, ultrafiltration (UF) and renal replacement therapies are
the treatment modalities implemented as monotherapy or in combination to
address this severe complication. There is limited data on the use of
simplified UF therapy as a fluid management strategy in post-operative
cardiac surgery patients. Methods: A retrospective review of
our post operative isolated CABG patients was done from Jan 1
st, 2020 to July 31 st, 2021. Those
subjected to a simplified UF protocol incorporating Goal Directed
Therapy (GDT) to treat fluid overload and/or acute kidney injury were
evaluated for 30-day survival and readmission rates. Results: A
total of 254 isolated CABG procedures were performed during this period.
Ultrafiltration was used in 17 (6.7%) patients. The 30-day mortality
for the entire CABG cohort was 5/254 (2.0%) patients and in the UF
group 0/17 (0%). The mean age of UF therapy patients was 65.8 years
(Range 41-89). The mean Society of Thoracic Surgeons STS mortality score
of UF patients was 5.7% (Range 0.6-50.0). The 30-day survival for the
17 patients placed on UF therapy was 100% and their readmission rate
was 2/17 (11.7%). Conclusions: The use of ultrafiltration in
this patient population with relatively high STS scores provided a safe
and effective modality to manage fluid balance but further studies are
needed.