Continuous hemodiafiltration in children after cardiac surgery.

Acute renal failure (ARF) after congenital cardiac surgery remains a serious complication and leading cause of morbidity and mortality. Continuous hemodiafiltration (CHDF) is presently accepted for pediatric applications. We retrospectively evaluated the effects of CHDF against ARF after congenital cardiac surgery at our hospital. We analyzed data from seven patients aged 23 days to 9 years and weighing 1.7-22.4 kg requiring dialysis therapy using CHDF after congenital cardiac surgery between April 2002 and January 2009. One patient who died could not be weaned from extracorporeal membrane oxygenation support and another died of multiple organ failure. Renal function recovered to normal in the other five (71%) patients. Treatment by CHDF lasted from 14 to 680 h and net ultrafiltration was 3.5 ± 1.4 mL/kg/h. Serum creatinine and urea concentrations were, respectively, 2.3 ± 1.6 and 43.7 ± 17.0 mg/dL before, and 0.5 ± 0.2 and 13.5 ± 8.1 mg/dL, after CHDF (P < 0.05). Thrombocytopenia developed in all patients, and platelet concentrates (0.76 ± 0.7 mL/kg/h) were infused during CHDF. Hypotension developed after changing the CHDF set in one patient. We suggest that CHDF is an effective alternative strategy for treating renal dysfunction after congenital cardiac surgery.

Extracorporeal membrane oxygenation circulatory support after congenital cardiac surgery.

Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia after cardiac surgery. We evaluated retrospectively, the efficacy of postoperative ECMO support following congenital cardiac surgery in our hospital. From April 2002 to February 2008, seven patients (median age 30 months) received postoperative mechanical support. Three had complete repair including Fontan circulation and four had palliative repair. In four patients, ECMO was initiated in the operating room, in three patients in the intensive care unit, postoperatively. Of the seven patients, one died on ECMO (support withdrawn), one died shortly after ECMO was discontinued, and five were successfully weaned and survived to hospital discharge. One of the survivors died 4 months after the operation due to pneumonia and septic shock. The mean duration of ECMO support was 121 hours (in survivors). During ECMO, the major complication was bleeding, despite adequate control of activated clotting time. We conclude that ECMO support for heart failure and respiratory insufficiency after congenital cardiac surgery was effective, and the result of ECMO support for respiratory insufficiency was better than for heart failure.