Ultrafiltration of priming blood before cardiopulmonary bypass attenuates inflammatory response and maintains cardiopulmonary function in neonatal piglets

Blood priming is necessary for cardiopulmonary bypass (CPB) in neonates to avoid excessive hemodilution; however, transfusion-related inflammation affects postCPB outcomes in neonatal open-heart surgery. We hypothesized that ultrafiltration of priming blood before CPB may reduce inflammatory mediators in priming blood and postCPB inflammatory responses, thereby improving cardiopulmonary function. Twelve 1-week-old piglets (3.5 ± 0.2 kg) were divided into two groups. Group U (n = 6) employed the priming blood ultrafiltrated before CPB, but group N (n = 6) used the nonultrafiltrated blood. Cardiopulmonary bypass was performed for 2 hours and then modified ultrafiltration (MUF) was conducted. Data were acquired before CPB and after MUF. The values of K, serotonin, and IL-8 in priming blood was significantly decreased after ultrafiltration (8.2 ± 2.6 vs. 4.2 ± 0.8 mEq/L, p < 0.01, 234 ± 96 vs. 74 ± 42 ng/ml, p < 0.01, 78.4 ± 5.1 vs. 64.5 ± 59.1 pg/ml, p < 0.05). Group U after MUF had lower thrombin-antithrombin complex levels (23.9 ± 5.1 vs. 33.7 ± 4.6 ng/ml, p < 0.01) and lower IL-8 levels in airway fluid (925 ± 710 vs. 2495 ± 1207 pg/ml, p < 0.05) than group N. Cardiac output and arterial PO2 after MUF in group U were also higher (1.13 ± 0.21 vs. 0.69 ± 0.22, p < 0.01, 340 ± 190 vs. 149 ± 84 mm Hg, p < 0.05). The ultrafiltration of blood priming before CPB attenuated activation of the coagulation pathway and inflammatory responses and preserved cardiopulmonary function in neonatal piglets.