Yonsei Med J.  2014 May;55(3):625-634. 10.3349/ymj.2014.55.3.625.

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

• Cho JE
• Shim JK
• Song JW
• Lee HW
• Kim DH
• Kwak YL

• KMID: 2068671
• DOI: http://doi.org/10.3349/ymj.2014.55.3.625

Abstract

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-alpha, 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.

Keyword

Blood coagulation; inflammation; cardiopulmonary bypass; cardiac surgical procedures

MeSH Terms

Aged
Blood Coagulation/drug effects
Cardiac Surgical Procedures/*methods
Cardiopulmonary Bypass/methods
Female
Humans
Hydroxyethyl Starch Derivatives/*therapeutic use
Male
Middle Aged
Hydroxyethyl Starch Derivatives

Figure

• 

  Fig. 1 Changes in inflammatory cytokines. (A) TNF-α, (B) IL-6, (C) IL-8. Data are expressed as median (maximum, minimum). *p<0.05, †p<0.005 compared with preCPB within group. HA, 5% human albumin; HES, 6% hydroxyethyl starch 130/0.4; CPB, cardiopulmonary bypass; TNF, tumor necrosis factor; IL, interleukin.

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