Use of intraoperative hetastarch priming during coronary bypass

Background: The use of hetastarch during coronary bypass surgery has been l imited 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 pr oduct transfusions and outcome after coronary bypass. Materials and methods: This nonrandomized retrospective study involved 887 patients who underwent isolated primary coronary artery bypass grafting. Ba sed on the type of solution used in priming the CPB circuitry, patients wer e 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 varia bles 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 comp arable (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 fro zen 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 ra te 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 primi ng solution. Conclusions: The use of hetastarch in priming CPB circuitry is devoid of an y added hemorrhagic risk after coronary bypass, and the type of prime solut ion for CPB has no influence on the early or late survival rates of patient s undergoing primary coronary bypass.