Priming and replenishment in cardiopulmonary bypass with hydroxyethyl starch 130/0.4 decreases fluid overbalance without renal dysfunction or bleeding in adult valve surgery

• Published in: General thoracic and cardiovascular surgery Vol. 67; no. 4; pp. 374 - 376
• Main Authors: Isoda, Susumu, Izubuchi, Ryo, Yamazaki, Ichiya, Nakayama, Yuta, Yano, Yoshimi, Masuda, Munetaka
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.04.2019; Springer Nature B.V
• Subjects: Blood; Cardiac Surgery; Cardiology; Creatinine; Heart surgery; Intubation; Medicine; Medicine & Public Health; Pilot projects; Rapid Communication; Surgical Oncology; Thoracic Surgery; Japan; Cardiopulmonary bypass; Hydroxyethyl starch; Valve surgery; Bleeding; Renal dysfunction
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-019-01091-w

The best priming and replenishment solution in cardiopulmonary bypass remains unknown, and the efficacy and drawbacks of artificial colloid are controversial. We retrospectively compared consecutive patients undergoing elective adult valve surgery in cases wherein cardiopulmonary bypass was primed and replenished with hydroxyethyl starch 130/0.4 ( n  = 12) or crystalloid solution ( n  = 11). The fluid overbalance during cardiopulmonary bypass was much lower in the hydroxyethyl starch 130/0.4 group (mean ± standard deviation, + 95 ± 1241 mL) than in the crystalloid solution group (+ 2921 ± 1984 mL) ( P  < 0.001). Renal function, intraoperative and postoperative bleeding, and blood products did not deteriorate with the use of hydroxyethyl starch 130/0.4. The postoperative intubation time was shorter in the hydroxyethyl starch 130/0.4 group (16.0 ± 2.6 h) than in the crystalloid solution group (18.7 ± 2.6 h) ( P  = 0.018). Although prospective randomized trials are needed to verify our findings, the impact of fluid balance differences requires serious consideration.