A novel hydroxyethyl starch (Voluven) for effective perioperative plasma volume substitution in cardiac surgery.
OBJECTIVE
To compare the new hydroxyethyl starch HES 130/0.4 (Voluven) and the standard HES 200/0.5 (pentastarch) regarding effectiveness for plasma volume substitution and safety of large volumes in heart surgery.


METHODS
Fifty-nine patients scheduled for coronary artery bypass grafting were enrolled in a prospective, randomised, double-blind, parallel-group, multicentre, clinical, phase III study. Hydroxyethyl starch was used as the exclusive artificial colloid for acute normovolemic hemodilution, priming of the heart lung machine, and for intra- and postoperative plasma volume substitution from induction of anesthesia until 16 hr after the end of surgery. Efficacy was evaluated by comparing the amount of colloid infused, hemodynamics, and colloid osmotic pressure (COP). Safety endpoints were blood loss, the use of allogeneic blood products, coagulation variables, and adverse events.


RESULTS
Effectiveness, as assessed by the total amount of infused HES volumes within the treatment period, was similar between HES 130/0.4 and HES 200/0.5 (2,550 mL +/- 561 mL vs 2,466 mL +/- 516 mL). Also, no differences were found for the use of other colloids (pasteurised plasma), hemodynamics, and COP In HES 130/0.4 patients, the postoperative increase of von-Willebrand factor (vWF) was higher (P < 0.01), blood loss was lower, and less packed red blood cells were transfused.


CONCLUSIONS
Hydroxyethyl starch 130/0.4 is an effective plasma volume expander in heart surgery and may be used as the sole artificial colloid to cover the perioperative period. We found a reduced influence of HES 130/0.4 on the physiologic postoperative increase of vWF.
Gallandat Huet
R C
RC
Department of Anesthesiology, University Hospital Groningen, The Netherlands. r.c.g.huet@anest.azg.nl
Siemons
A W
AW
Baus
D
D
van Rooyen-Butijn
W T
WT
Haagenaars
J A
JA
van Oeveren
W
W
Bepperling
F
F
D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009997:Osmotic Pressure / Q000187:drug effects; D010952:Plasma Substitutes / Q000627:therapeutic use*; D010953:Plasma Volume / Q000187:drug effects*; D014841:von Willebrand Factor / Q000378:metabolism
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D014841:von Willebrand Factor