Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery?

Hetastarch is used for intravascular volume expansion in cardiac surgery. S tudies show conflicting effects of intraoperative hetastarch administration on postoperative bleeding. Hetastarch was routinely used for volume expans ion during cardiovascular surgeries at our institution until its use was di scontinued intraoperatively. We performed a retrospective chart review on p atients undergoing primary coronary artery bypass grafting, valve repair or replacement requiring cardiopulmonary bypass (n = 444), 234 of which recei ved intraoperative hetastarch and 210 did not. There was no difference in d emographics, cardiac surgery, or cardiopulmonary bypass duration between th e two groups. Blood loss for 0-4 h postoperatively was 377 +/- 244 mt in th e group not receiving hetastarch compared with 515 +/- 336 mt in the group that received hetastarch (P < 0.001). For 0-24 h postoperatively, blood los s was 923 +/- 473 mt versus 1,283 +/- 686 mt in the absence and presence of hetastarch, respectively (P < 0.001). Allogeneic transfusion requirements (cryoprecipitate, fresh frozen plasma, and platelets) were larger in the he tastarch group tall P < 0.001). Nearly all (99%) patients in the hetastarch group received less than the manufacturer's recommended dose (20 mL/kg) of hetastarch. Implications: Our large retrospective study suggests that intr aoperative use of hetastarch in primary cardiac surgery with cardiopulmonar y bypass may increase bleeding and transfusion requirements. A large prospe ctive study is needed to determine if intraoperative administration of heta starch should be avoided during cardiovascular surgery.