title: Hydroxyethyl starch for cardiovascular surgery: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  The objective of this study was to appraise the safety profiles of HES preparations and to find out which HES preparation was the most acceptable in cardiovascular surgery through a comparison with control solutions.
  
  
  METHODS
  Pertinent randomized controlled trials were selected through a search of Pubmed, Embase, and Cochrane Controlled Trials Register. Quantitative and qualitative analysis was carried out to evaluate blood loss, blood transfusion, renal function, complications, reoperation, and mortality.
  
  
  RESULTS
  A total of 3,234 patients from 52 randomized controlled trials were included. HES preparations versus control solutions in blood loss: HES 130 kD vs. albumin (SMD -0.61, 95% CI -0.82, -0.40), HES 200 kD vs. albumin (SMD -0.01, 95% CI -0.29, 0.28), HES 450 kD vs. albumin (SMD 0.47, 95% CI 0.26, 0.68). When comparing control solutions with HES preparations, 50% (HES 450 kD), 40.9% (HES 200 kD), and 18.2% (HES 130 kD) of the comparisons showed more blood/blood products infusion with HES than with control solutions. A numerically lower mortality rate seemed to be related to HES preparations (2.68 vs 4.23%). No difference was found in terms of complications, renal failure, or reoperation.
  
  
  CONCLUSIONS
  Perioperative administration of HES preparations is comparatively safe. The data appraising safety profiles of HES preparations are insufficient to make direct comparisons among themselves. As the third generation of HES preparations, HES 130 kD showed a trend toward lower blood loss and transfusion rates and is a suitable choice for cardiovascular surgery.
authors.affiliation: Department of Anaesthesiology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China. shixueyin1128@yahoo.com.cn
authors.forename: Xue-Yin
authors.initials: XY
authors.lastname: Shi
authors.forename: Zui
authors.initials: Z
authors.lastname: Zou
authors.forename: Xing-Ying
authors.initials: XY
authors.lastname: He
authors.forename: Hai-Tao
authors.initials: HT
authors.lastname: Xu
authors.forename: Hong-Bin
authors.initials: HB
authors.lastname: Yuan
authors.forename: Hu
authors.initials: H
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use; D007223:Infant; D008875:Middle Aged; D008970:Molecular Weight; D019990:Perioperative Care; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes