ultrafiltration for cirrhotic patients during cardiopulmonary bypass: egyptian experience. dr....
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Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass:
Egyptian Experience.
Dr. Mohamed R. El–Tahan, M.D.
Assistant Prof of Anaesthesia & SICU, Dammam University ,
Dammam, Saudi Arabia,
Associate Prof. of Cardiothoracic Anaesthesia, Mansoura
University, Mansoura, Egypt,
Member of the European Association of Cardio-Thoracic
Anaesthetists,
Member of the Association of Cardio-Thoracic Anaesthetists of
UK,
Member of the Association of Anaesthetists of Great Britain and
Ireland, UK
Instructor for ALS & EPLS, European Resuscitation Council, UK.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 4: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/4.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 5: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/5.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 6: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/6.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 7: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/7.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 8: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/8.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 9: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/9.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 10: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/10.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 11: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/11.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 12: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/12.jpg)
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Objectives
![Page 13: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/13.jpg)
The hill of
schistosomiasis in
the Nile Delta,
Lower and Upper
Egypt
Egypt is the Gift of the Nile
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Egypt has possibly the highest HCV
prevalence worldwide (10%–20%)
and is the leading cause of chronic
liver disease and hepatocellular
carcinoma.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Patients with mild or moderate cirrhosis have
prolonged hospitalization and high mortality
and morbidity rates after cardiac surgery using
cardiopulmonary bypass.
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Child-Pugh A Child-Pugh B Child-Pugh C0%
10%20%30%40%50%60%70%80%90%
100%
60%
100% 100%
0%
50%
100%Complications Mortality
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Chest-tube output
1113
849
Propensity-score pair-matched control group Cirrhosis
*
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Re-exploration rate Postcardiotomy syndrome and pleurisy
0%1%2%3%4%5%6%7%8%9%
9% 9%
0% 0%
Cirrhosis Propensity-score pair-matched control group
* *
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Thirty-day mortality 8 years survival0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
19.10%
70.20%
8.50%
85.70%
Cirrhosis Propensity-score pair-matched control group
*
*
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Worsening postoperative function of vital
organs may be attributed to the SIRS and
capillary leak syndrome caused by CPB.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The concept of removing excess fluid from the
intravascular space of patients in renal failure
by the filtration of blood through an
ultraporous membrane dates back to 1928.
• Brull L. Realization de l'ultrafiltration in vivo. C R Soc Biol (Paris) 1928;99:1605–1608.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Unfortunately, the first clinical applications of
ultrafiltration in patients with renal failure did
not occur until the 1952.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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During the 1970s, Lee West Henderson was the
first who used the UF during open heart
surgery.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Ultrafiltration is the selective separation of
plasma water and LMW solutes from the
intravascular cellular components and plasma
proteins, using a semipermeable membrane
filter.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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UF is being categorized by the timing and
technique used in the UF process:
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Conventional ultrafiltration is performed during
CPB (usually during the rewarming phase) and
the volume removed is based on the volume
within the CPB circuit.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Modified ultrafiltration refers to the use of
ultrafiltration after the stabilization of the
patient’s hemodynamics after CPB.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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An ultrafilter is placed with the inlet connected to the aortic cannula and the outlet
connected to the right atrium via the venous catheter.
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Blood flow rate through the filter is maintained
at 200 to 300 mL/min to produce an UF rate of
100 to 150 mL/min
Infusion rates is adjusted to maintain
appropriate CVP or LAP.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The MUF removed volume after CPB is 20 to 30
mL/kg.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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TRAPtest ASPItest ADPtest0
10203040506070
44
22 28
65
52
39
Control N-MUF
**
*
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Chest tube output 24 hrs Chest tube output 48 hrs0
200400600800
100012001400 1075
1400
890 900
Control N-MUF
* *
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Continuous ultrafiltration (CUF+MUF) is a
technique that using both CUF and MUF during
and after the cessation of CPB, respectively.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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CUF attenuates the inflammatory response,
increases hemoglobin conc. and platelets,
improves hemodynamics, decreases the need
for transfusion, postoperative ventilation and
ICU stay.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Extubation time ICU stay0
10203040506070
10
56
8
66
9
44
CUF MUF Both
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Semi-continuous UF throughout CPB but it is
interrupted during weaning from CPB.
Allow UF rate = the crystalloid cardioplegia
volume + 40–70 mL/kg/hr.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Adding small aliquots of crystalloid < 20 mL/kg
as necessary to maintain a safe blood level in
the venous reservoir.
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Contributing factors for adverse outcome in cirrhotic
patients after CPB include:
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
no pulsatile flow,
hemodilution,
hemolysis,
activation of the inflammatory cascade,
anticoagulation,
hypothermia,
and reduced end-organ perfusion.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
The Royal Hall Harrogate International Centre, King’s Road, Harrogate, 2008.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
![Page 66: Ultrafiltration for Cirrhotic Patients during Cardiopulmonary Bypass: Egyptian Experience. Dr. Mohamed R. El–Tahan, M.D](https://reader036.vdocuments.us/reader036/viewer/2022062307/551b48ea550346d31b8b4ba0/html5/thumbnails/66.jpg)
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We postulated that CUF + MUF may decrease
the need for transfusion and shorten the
durations of ventilation and ICU stay in the
cirrhotic patients after valve surgery.
Hypothesis
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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A priori power analysis indicated that 30
patients in each group would be a sufficiently
sample size to detect a 20% reduction in
aminotransferase values, with a type-I error of
0.05 and a power of 87%.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Sixty cirrhotic ASA II – IV patients (Child-Pugh
Grade A–C) scheduled for valvular heart
surgery using CPB were studied.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Patients with history of IHD, LV dysfunction,
cirrhotic cardiomyopathy, thyrotoxicosis,
neurological, renal diseases, pregnancy,
preoperative circulatory or ventilatory
support, or re-do or emergency surgery were
excluded.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The CUF group (n = 30) conventional
ultrafiltration was used.
CUF volume of 20 – 30 mL kg-1 was removed
during CPB and it was stopped if the venous
reservoir level fell low.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The CUF+MUF group (n = 30) conventional
ultrafiltration was performed during CPB and
MUF was performed after termination of CPB.
MUF volume of 20 – 30 mL kg-1 was removed
after CPB.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The target volume for UF removal was:
(priming solution + any additional fluid during
CPB) – (CUF fluid + UOP during bypass).
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Perioperative LFTs, haematocrit, platelet
count, doses of inotropic support, the time to
extubation, the durations of the postoperative
ventilation and ICU and hospital stays were
recorded.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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MELD Score
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71.3% mortality
52.6% mortality
19.6% mortality
6.0% mortality
1.9% mortality
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Un-paired student t- test and Mann-Whitney U
test were used as appropriate with repeated
measure analysis of variance.
Methods
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The main causes of hepatic cirrhosis were
hepatitis C in 47 (78.3%), hepatitis B in 10
(16.7%), and undetermined conditions in 3
(5%).
Results
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
CUF CUF + MUF(n=30) (n=30)
Age (years) 27.3±7.8 28.4±8.3Sex (M/F) 21 / 30 (70%) 18 / 30 (60%)Weight(Kg) 67.5±11.6 73.4±9.2Height(cm) 166.5±3.7 167.2±4.3Child-Pugh
Grade A 14 (46.7%) 11 (36.7%)Grade B 13 (43.3%) 15 (50%)Grade C 3 (10%) 4 (13.3%)
MELD score 20 [21] 19 [23]EuroSCORE 3.7 [6] 3.2 [6]Height(cm) 166.5±3.7 167.2±4.3Types of surgery
Aortic valve replacement 9 (30%) 12 (40%)Mitral valve replacement 14 (46.7%) 10 (33.4%)Double valve replacement 5 (16.6%) 4 (13.3%)Triple valve Surgery 2 (6.7%) 4 (13.3%)
CPB time (min) 102.4±20.5 110.1±27.3Aortic clamping time (min) 57.5±25.1 60.2±28.8
Table (1): Patients data.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
CUF CUF + MUF P value(n=30) (n=30)
NTG dose (µg kg-1 min-1) 1.7±0.67 1.9±2.1 0.770
Epinephrine dose (ng.kg-1.min-1) 97±40.01 102±27.3 0.814
Volume of CUF (mL) 1687.5±278.4 1908.4±202.4 0.671
Volume of MUF (mL) 1541.4±239.23
Time to extubation (hrs) 10.3±5.61 6.3±2.61 0.006
Ventilation time (hrs) 8.6±6.21 5.5±2.41 0.007
Perioperative bleeding (mL) 1064±337.13 808±137.42 0.02
PRBCs transfusion (n) 4.4±1.32 2.8±0.82 0.004
ICU length of stay (days) 7.6±3.91 4.1±1.61 0.02
Hospital length of stay (days) 18.7±10.6 10.4±2.11 0.03
Mortality (n(%)) 2 (6.7%) 1 (3.3%) 0.481
Table (2): Clinical data.
Data are mean ± SD and number (%). * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Baseline 15 min 30 min 1 h 6 h 12 h 24 h0
5
10
15
20
25
30
35
40
45CUF CUF + MUF
Time
Hae
mat
ocrit
(%)
*
Figure (1): Haematocrit (%) changes.
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Baseline 15 min 30 min 1 h 6 h 12 h 24 h0
5
10
15
20
25
CUF CUF + MUF
Time
Plat
elet
s (1
04/µ
mL)
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
Figure (2): Platelets (104/µmL) changes.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Group Postoperative
Baseline 12 h Day 1 Day 3 Day 7
AST (IU/L) CUF 47.2±22.63 101.1±27.83 137.7±51.42 124.9±26.54 88.9±27.94
CUF + MUF
39.9±19.17 50.5±25.64 * 84.1±29.14 * 90.7±14.74 * 53.6±18.92 *
ALT (IU/L) CUF 46.7±22.43 112.4±31.23 152.1±31.44 134.8±31.23 98.9±37.81
CUF + MUF
38.5±18.93 55.7±21.54 * 82.1±14.91 * 96.6±13.64 * 59.2±16.50 *
ALP (IU/L) CUF 154.9±101.6 211.1±114.62 255.8±120.63 283.2±122.60 222.5±128.90
CUF + MUF
161.3±79.30 176.4±74.42* 186.4±74.42* 166.1±60.53* 127.7±54.80 *
GGTP (IU/L) CUF 112.9±67.13 196.0±80.34 224.0±85.41 208.4±80.24 189.1±78.61
CUF + MUF
115.8±65.94 136.0±61.80* 176.6±56.40* 139.8±49.21* 121.7±42.84 *
Table (3): Liver enzymes changes.
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Baseline 12 h Day 1 Day 3 Day 70
0.5
1
1.5
2
2.5
3
3.5
4
4.5CUF CUF + MUF
Time
Bilir
ubin
(mg
dL-1
)Figure (3): Bilirubin (mg dL-1) changes.
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Baseline 12 h Day 1 Day 3 Day 70
0.5
1
1.5
2
2.5
3
3.5
4
4.5CUF CUF + MUF
Time
Albu
min
(gm
dL-
1)Figure (4): Albumin (gm dL-1) changes.
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Baseline 12 h Day 1 Day 3 Day 70
5
10
15
20
25
30
35CUF CUF + MUF
Time
Prot
hrom
bin
time
(sec
)Figure (5): Prothrombin time (sec) changes.
Data are mean ± SD. * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
CUF CUF + MUFP value
(n=30) (n=30)
Coagulopathy 4 (13.3%) 2 (6.7%) 0.770
Pulmonary 1 (3.3%) 0 (0%) 0.814
Renal 1 (3.3%) 0 (0%) 0.556
New onset or worsening of ascites 5 (16.7%) 3 (10%) 0.477
Encephalopathy 3 (10%) 1 (3.3%) 0.442
Wound dehiscence or infection 1 (3.3%) 2 (6.7%) 0.544
Mortality 2 (6.7%) 1 (3.3%) 0.544
Table (4): Perioperative Complications.
Data are number (%). * P< 0.05 significant compared with CUF group.
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Limitations
The studied population is quite different from
other institutions with the extreme youth of
the studied patients (30 years).
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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The small BMI (24-26 kg/m2) of the studied
population would have a significant
hemodilutional effect from CPB & the use of
CUF+MUF might have a greater effect than
with a larger size population.
Limitations
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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We concluded that CUF + MUF reduced
postoperative bleeding and transfusions,
improved liver function and shortened the
hospital stay in cirrhotic patients after valvular
heart surgery.
Conclusion
Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
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Introduction Cardiac Surgery & Cirrhosis History of UF Principle of UF Types of UF
MUF CUF DUF UF & Cirrhosis Our Study
Summary
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Thank You