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Use of Intraoperative Hetastarch Priming During Coronary Bypass^*

^* From the Division of Cardiothoracic Surgery (Dr. Canver), Albany Medical College, Albany, NY; and William S. Middleton Memorial Veterans Hospital (Mr. Nichols), Madison, WI.

Correspondence to: Charles C. Canver, MD, FCCP, Division of Cardiothoracic Surgery, Albany Medical College, 47 New Scotland Ave, Mail Code S5, Albany, NY; e-mail: CanverC{at}mail.amc.edu

Background: The use of hetastarch during coronary bypass surgery has been limited due to its unresolved potential risk for hemorrhage. Therefore, the purpose of this study was to investigate the effects of using 6% hetastarch in priming cardiopulmonary bypass (CPB) circuitry on the need for blood product transfusions and outcome after coronary bypass.

Materials and methods: This nonrandomized retrospective study involved 887 patients who underwent isolated primary coronary artery bypass grafting. Based on the type of solution used in priming the CPB circuitry, patients were stratified into the following four different groups: group 1, crystalloid (500 mL; n = 211); group 2, 25% human albumin (50 mL; n = 217); group 3, 6% hetastarch (500 mL; n = 298); and group 4, 25% human albumin (50 mL) and 6% hetastarch (500 mL; n = 161). Patient characteristics and clinical variables were compared among the groups using the Kruskal-Wallis test. Patient survival estimates were compared using log-rank test.

Results: Demographic patient characteristics for all groups were similar (p > 0.05). Intraoperative and perioperative variables among groups were comparable (p > 0.05). The use of hetastarch as a part of prime solution in CPB circuitry did not alter the need for banked blood, platelets, or fresh frozen plasma transfusions (p > 0.05). The length of stay in the ICU or in the hospital was unaffected in all groups. The early (ie, 30-day) mortality rate was 1.4% in group 1, 1.8% in group 2, 1.0% in group 3, and 3.1% in group 4. Long-term survival among the groups was unaffected by the type of priming solution.

Conclusions: The use of hetastarch in priming CPB circuitry is devoid of any added hemorrhagic risk after coronary bypass, and the type of prime solution for CPB has no influence on the early or late survival rates of patients undergoing primary coronary bypass.

Key Words: cardiopulmonary bypass • coronary bypass • hetastarch • transfusions

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