The Status of Plasma Expanders in Open Heart Surgery

¹ National Heart Institute, United States Public Health Service

In terms of the safety achieved, we were probably justified in the use of almost extravagant quantities of homologous whole blood in the initial years of open heart surgery. Our knowledge of the physiologic and mechanical problems of open heart surgery has advanced rapidly during the last seven years. Certainly not all of the problems have been solved. At least two minor problems, that of intravascular aggregation and protein denaturation have been solved, however, by the use of Rheomacrodex. There are no apparent reasons why plasma expanders should not be used as partial blood substitutes in open heart surgery. Theoretically, it should be possible to avoid the use of homologous blood entirely. Blood loss due to hemorrhagic diatheses has been greater in patients subjected to open heart surgery than in closed heart surgery. Only with the use of better apparatus and less homologous blood will it be ascertained whether or not this bleeding is related to massive transfusion. With the hemodilution of the patient's blood and the prevention of aggregation, damage to corpuscular elements is proportionately decreased.