The effects of hydroxyethyl starch (130/0.4) as the priming solution on microcirculation in coronary bypass grafting (CABG) surgery

Abstract

Introduction. Hydroxyethyl starch (HES) solution is used as a priming solution in cardiopulmonary bypass (CPB) on adult patients but its effects on microcirculation is unclear. Thus, the present investigation was performed to compare the effects of RL and HES as the priming solutions on microcirculation in CABG surgery. Methods. Following ethical committee approval and informed consent, 20 patients who underwent CABG surgery were included in this study. During CPB, Group RL received Ringer’s Lactate(n:10) and Group HES received HES (130/0,4)(n:10) as priming solution. Demographic, clinical and haemodynamic parameters were recorded. SDF imaging technique was used to evaluate the sublingual microcirculation. Haemodynamic variables (HR, MAP, CVP, CO, PCWP), laboratory parameters (Htc, BUN, creatinine, lactate and Kþ) and microcirculatory variables (Total vascular density-TVD (mm/ mm), microvascular flow index-MFI (AU), perfused vessel densityPVD (mm/ mm), proportion of perfused vessels-PPV (%) and heterogeneity of perfusion -PPVHI (%) of vessels were obtained after induction, before CPB, during CPB, at the end of the operation and at the 24 hour. These images have been analysed by using AVA (Automated Vascular Analysis) software. Results. In the two groups, changes in TVD and PVD values occurred during CPB period (po0.05). In the HES group, small vessels of TVD from 15.75 (13.14-17.61) to 13.40 (7.55-15.49) and PVD from 15.05 (12.27-16.96) to 12.53 (7.24-15.20) were decreased. In the RL group, small vessels of TVD from 13.23 (8.86-17.76) to 9.98 (8.36-15.65) and PVD from 13.68 (9.8818.01) to 10.68 (6.17-15.84) were decreased. While these parameters return to baseline values at the end of the surgery in the HES group, in the RL group, these changes remained until at the 24 hour. The PPV and PPVHI values did not change in both groups (p40.05). MFI in small sized vessels in group HES were lower than in group RL (po0.05) but these values did not affect in both groups at any time (p40.05) Conclusion. We concluded that HES (130/0.4) could be used as the CPB priming solution in patients undergoing cardiac surgery but it may have not some advantages to improve microcirculation.