Exploring the effects of hemodialyzers on clinical outcomes in pediatric cardiac surgery during cardiopulmonary bypass: a retrospective cohort study

BackgroundHemofiltration during and after cardiopulmonary bypass (CPB) reduces levels of proinflammatory cytokines and total interstitial body water. Because of economic causes, hemofilters became less available in low- and middle-income countries, which forced the perfusionists to use hemodialyzers instead. This study aimed to assess the clinical outcomes of pediatric patients who had hemodialyzers instead of hemofilters during CPB. We performed a retrospective cohort study of 46 pediatric patients who underwent cardiac surgery between January 1st, 2023, and September 30th, 2023. Patients included were those who required hemofiltration during CPB.ResultsThe median age and weight were 0.95 years [0.28, 2.76] and 7.5 kg [5.2, 13.6], respectively. Tetralogy of Fallot repair represented 24% of cases. CPB and aorta cross-clamp times averaged 93.0 +/- 32.6 min and 60.1 +/- 24.2 min, respectively. The overall mortality rate was 6.5% (n = 3). Among the deceased, all had RACHS-1 (Risk Adjustment in Congenital Heart Surgery) score 4. Mortality in the deceased group was linked to several significant factors compared to the survivors, including, lower CPB temperature (28 degrees C vs. 32 degrees C), higher lactate levels (2.9 +/- 0.9 vs. 1.9 +/- 0.7 mmol/L), longer mechanical ventilation duration (288 vs. 21 h), and prolonged Intensive Care Unit stay (12 vs. 3 days). CPB time, aorta cross-clamp time, or post-CPB hematocrit did not significantly differ between survived and deceased patients.ConclusionsIn this retrospective analysis of 46 pediatric patients, the use of hemodialyzers for hemofiltration during CPB could be safe with acceptable mortality rate. While these preliminary findings are promising, the sample size and retrospective design limit generalizability. Further prospective studies with larger cohorts are warranted to more effectively evaluate the safety and efficacy of hemodialyzers as an alternative to hemofilters.