Priming and replenishment in cardiopulmonary bypass with hydroxyethyl starch 130/0.4 decreases fluid overbalance without renal dysfunction or bleeding in adult valve surgery

The best priming and replenishment solution in cardiopulmonary bypass remains unknown, and the efficacy and drawbacks of artificial colloid are controversial. We retrospectively compared consecutive patients undergoing elective adult valve surgery in cases wherein cardiopulmonary bypass was primed and replenished with hydroxyethyl starch 130/0.4 (n=12) or crystalloid solution (n=11). The fluid overbalance during cardiopulmonary bypass was much lower in the hydroxyethyl starch 130/0.4 group (mean +/- standard deviation, + 95 +/- 1241mL) than in the crystalloid solution group (+2921 +/- 1984mL) (P<0.001). Renal function, intraoperative and postoperative bleeding, and blood products did not deteriorate with the use of hydroxyethyl starch 130/0.4. The postoperative intubation time was shorter in the hydroxyethyl starch 130/0.4 group (16.0 +/- 2.6h) than in the crystalloid solution group (18.7 +/- 2.6h) (P=0.018). Although prospective randomized trials are needed to verify our findings, the impact of fluid balance differences requires serious consideration.