Is crystalloid cardioplegia a strong predictor of intra-operative hemodilution?
BACKGROUND
Complications due to hemodilution (hematocrit value less than 22%) after cardiopulmonary bypass inevitably resulted with significantly greater intensive care requirements, long hospital stays, more operative costs, and increased mortality rates. We tried to identify whether crystalloid cardioplegia is the strongest predictor of intraoperative hemodilution or not.


METHODS
One hundred patients were included into this randomized prospective study. Patients were divided into the two groups. Crystalloid cardioplegia were given to the odd-numbered patients (Group 1, n=50 patients) and blood cardioplegia were given to the even-numbered patients (Group 2, n=50 patients). St. Thomas-II solution was used in Group-1 and Calafiore cold blood cardioplegia was in Group-2.


RESULTS
Average intraoperative hematocrit value was 18.4% ± 2.3 in crystalloid group 24.2% ± 3.4 in blood cardioplegia group (p<0.001). The lowest hematocrit value was 15% and 20% in two groups respectively (p<0.001). In crystalloid group average intraoperative packed red blood cell (RBC) transfusion was 2.3 ± 0.41 units, 0.7 ± 0.6 units blood cardioplegia group (p=0.001). Average transfused RBC was 2.7 ± 0.8 units in crystalloid group, 0.9 ± 0.4 units blood cardioplegia group (p<0.001). Multivariate analyses confirmed age (p = 0.005, OR = 3.78), female gender (p = 0.003, OR = 2.91), longer cross-clamp time (>60 minutes) (p = 0.001, OD = 0.97), body surface area <1.6 m2 (p = 0.001, OR = 6.01) and crystalloid cardioplegia (p < 0.001, OR = 0.19) as predictor of intraoperative hemodilution.


CONCLUSIONS
Crystalloid cardioplegia, compared to blood cardioplegia not only causes much more intra-operative hemodilution but also increases the blood transfusion requirement. Hemodilution and increased transfusion increases the intensive care unit and hospital stay, in the early postoperative period.
Murat
M
Günday
Department of Cardiovascular Surgery, Ankara Çankaya Hospital, Aşağı Dikmen mah, 575 sok, Orankent konutları B blok No:12, OR-AN Çankaya, Ankara, Turkey. hbingol@gmail.com.
Hakan
H
Bingöl
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D000077324:Crystalloid Solutions; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods*; D006400:Hematocrit; D006438:Hemodilution / Q000009:adverse effects*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007552:Isotonic Solutions / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000077324:Crystalloid Solutions; D006454:Hemoglobins; D007552:Isotonic Solutions