Effects of hypertonic saline-dextran solution in cardiac valve surgery with cardiopulmonary bypass.
BACKGROUND
Hypertonic saline-dextran (HSD) solution may be beneficial in patients undergoing coronary artery surgery with cardiopulmonary bypass. Valvular dysfunction is associated with high pulmonary wedge pressure, pulmonary hypertension, and ventricular dysfunction. Fluid overload or transient left ventricular failure may occur with HSD infusion in such patients. This study evaluates the cardiorespiratory effects and tolerance of HSD solution infusion in patients undergoing cardiac valve surgery.


METHODS
This prospective, randomized, double-blind study compared clinical, laboratory, hemodynamic, and respiratory measurements, and fluid balance in 50 patients over a 48-hour period after cardiopulmonary bypass for cardiac valve surgery. Twenty-five patients received 4 mL/kg of HSD during 20 minutes before cardiopulmonary bypass (HSD group). The control group received the same volume of Ringer's solution (Ringer group).


RESULTS
Hospital mortality was zero. The HSD patients had a near zero fluid balance (6.5 +/- 13.5 mL/Kg/48 hours), and the control patients had a positive balance (91.0 +/- 33.7 mL/Kg/48 hours). Hemoglobin was similar in both groups, but more blood transfusions were necessary in the Ringer group (1.21 +/- 1.28 vs 0.48 +/- 0.59 units per patients). The HSD solution induced a higher cardiac index and left ventricular systolic work index postoperatively, and a lower systemic vascular resistance index until 6, 24, and 48 hours. Right ventricular systolic work index increased and pulmonary vascular resistance index decreased after HSD infusion. A better Pao(2)/Fio(2) relation was observed at 1 and 6 hours postoperatively in the HSD group and was associated with a shorter extubation time (432.0 +/- 123.6 vs 520.8 +/- 130.2 minutes). Increased oxygen delivery index occurred in the HSD group. The HSD infusion was well tolerated as none of the patients experienced fluid overload or had left ventricular failure develop. No other complication attributable to the use of HSD solution was observed.


CONCLUSIONS
The HSD solution infusion in patients during cardiac valve surgery with cardiopulmonary bypass was well tolerated. Hemodynamic and respiratory functions improved and fluid balance was near zero during the first 48 hours as compared with a large positive balance in the control group. We conclude that HSD infusion is advantageous for patients undergoing cardiac valve surgery.
Bueno
Ronaldo
R
Department of Cardiovascular Surgery, Beneficência Portuguesa Hospital, São Paulo, Brazil. rmbueno@matrix.com.br
Resende
Adailton Carvalho
AC
Melo
Ricardo
R
Neto
Vicente Avila
VA
Stolf
Noedir A G
NA
D000328:Adult; D001938:Brazil; D002315:Cardiopulmonary Bypass; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010101:Oxygen Consumption / Q000187:drug effects; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage* / Q000009:adverse effects; D014882:Water-Electrolyte Balance / Q000187:drug effects
D003911:Dextrans; D012462:Saline Solution, Hypertonic