Congestive heart failure Ultrafiltration

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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
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Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

In the setting of congestive heart failure, ultrafiltration has been associated with a reduced incidence of hospitalization compared with diuretics in the UNLOAD trial, but no difference in mortality.

Ultrafiltration

Mechanism

Ultrafiltration removes plasma water from whole blood. Possible benefits of ultrafiltration include:

• Provides fluid regulation

• Relieve pulmonary edema
• Reduce ascites and/or peripheral edema
• Hemodynamic stabilization
• Improve oxygenation
• Facilitates blood product replacement without excess volume
• Enable parenteral nutritional support without excess volume

• Improves solute regulation

• Correct acid-base balance
• Correct serum sodium content
• Eliminate myocardial depressant factors or known toxins
• Correct uremia
• Correct hyperkalemia
• Correct other electrolyte disturbances

• Helps to establish homeostasis

• Reset water omostat
• Restore diuretic responsiveness
• Reduce neurohormonal activation

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT)

Ultrafiltration in Patients Presenting With Heart Failure (DO NOT EDIT)

Class IIa

"1. Ultrafiltration is reasonable for patients with refractory congestion not responding tomedical therapy. (Level of Evidence: B) "

Vote on and Suggest Revisions to the Current Guidelines

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

External Links

• 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult