Continuous hemofiltration for the failing heart.

The effect of hemofiltration (HF) was studied in three different groups of patients with severe heart failure refractory to inotropic support. Group I consisted of 72 patients who were treated preoperatively with HF. In 1,350 patients (group II) undergoing several kinds of open heart surgery, HF was performed during cardiopulmonary bypass. In a third group (520 patients), HF was used postcardiotomy cardiogenic shock. Hemodynamic, metabolic, and PO2 measurements were obtained before, during, and after continuous HF. During 2 to 24 hrs of continuous HF, an increase in mean arterial pressure left ventricular stroke work index, and total peripheral resistance, as well as a decrease in left atrial pressure, were seen in groups II and III. In group I, all hemodynamic variables improved significantly; afterload and preload decreased, reversing cardiac dysfunction and restoring renal function. Continuous HF eliminates cardiopulmonary toxic metabolites (partly responsible for multiorgan dysfunction) from the plasma of patients with severe cardiac failure. The preliminary results indicate that the early use of HF offers an effective treatment which prolongs life in acute and severe congestive heart failure.