Effect of 6% hydroxyethyl starch 130/0.4 as a priming solution on coagulation and inflammation following complex heart surgery.
OBJECTIVE
Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery.


METHODS
Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-α, interleukin-6, and interleukin-8) were performed.


RESULTS
Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137±34 min, HES-HES; 136±47 min, albumin-nonHES; 132±39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups.


CONCLUSIONS
Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.
Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea.
Jang-Eun
JE
Cho
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Jae-Kwang
JK
Shim
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Jong-Wook
JW
Song
Jong-Won
JW
Song
Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea.
Hye-Won
HW
Lee
Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea.
Dong-Hwan
DH
Kim
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Young-Lan
YL
Kwak
D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D006895:Hydroxyethyl Starch Derivatives
Blood coagulation; cardiac surgical procedures; cardiopulmonary bypass; inflammation