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Title: Venoarterial modified ultrafiltration versus conventional arteriovenous modified ultrafiltration during cardiopulmonary bypass surgery
Authors: Mohanlall, Rakesh 
Issue Date: 2009
INTRODUCTION: The role of modified ultrafiltration (MUF) in removing inflammatory mediators,
reducing the need for homologous donor blood and decreasing pulmonary vascular resistance after
cardiopulmonary bypass (CPB) has already been established. Different types of MUF systems
evaluated illustrated that none of the MUF techniques adhered to the normal venous to arterial blood
flow dynamics.
OBJECTIVES: This experimental study compared a conventional arteriovenous modified
ultrafiltration (AVMUF) system to a custom designed venoarterial modified ultrafiltration (VAMUF)
system. This technique of VAMUF was designed to mimic the pro-grade flow pattern of the body and
cardiopulmonary bypass circuit as compared to the conventional retrograde AVMUF systems.
METHODS: Sixty patients that underwent MUF were divided into two groups, the AVMUF (n = 30)
and the VAMUF (n=30) groups. Modified ultrafiltration was performed for a mean time of 12
minutes in both groups. In AVMUF blood was removed from the aorta, haemoconcentrated and
infused into the right atrium (RA). In VAMUF blood flow was from the RA through a
haemoconcentrator and re-infused into the aorta.
RESULTS: There was no significant difference in any of the demographic variables, CPB or crossclamping
time. Results showed significant difference in the ventilation times, with the VAMUF
requiring a shorter ventilation time than the AVMUF group. Intensive care unit (ICU) stay, Hospital
stay and discharge days were all significantly lower in the VAMUF group as well. The VAMUF also
showed a lower percentage fluid balance than the AVMUF. The systolic and mean blood pressure was
significantly higher after VAMUF with a decrease in heart rate, and central venous pressure (CVP).
The VAMUF group showed a significantly greater decrease of Creatinine, serum lactacte and uric
acid over time with no significant differences in oximetry.
CONCLUSION: Results prove that VAMUF is more effective compared to the conventional
AVMUF regarding the haemodynamics and clinical parameters of the patient and is more
physiological with regards to blood flow dynamics. The VAMUF is, therefore, a more physiological
technique than AVMUF.
Submitted in fulfillment of the Degree of Doctor of Technology: Clinical Technology, Durban University of Technology, Durban, South Africa, 2009.
Appears in Collections:Theses and dissertations (Health Sciences)

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