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Effect of 6% Hydroxyethyl Starch 130/0.4 as a Priming Solution on Coagulation and Inflammation following Complex Heart Surgery

PURPOSE:

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.

MATERIALS AND 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.

CONCLUSION:

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.


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