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Ann Thorac Surg 2004;77:604-611
© 2004 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, Beneficência Portuguesa Hospital, São Paulo, Brazil
b Department of Cardiovascular Surgery, Instituto do Coração, University of São Paulo, São Paulo, Brazil
Accepted for publication July 30, 2003.
* Address reprint requests to Dr Bueno, R. Loureiro da Cruz 121-22, Aclimação, CEP-01529-020, São Paulo, Brazil.
e-mail: rmbueno{at}matrix.com.br
BACKGROUND: Hypertonic saline-dextran (HSD) solution may be beneficial in patients undergoing coronary artery surgery with cardiopulmonary bypass. Valvular dysfunction is associated with high pulmonary wedge pressure, pulmonary hypertension, and ventricular dysfunction. Fluid overload or transient left ventricular failure may occur with HSD infusion in such patients. This study evaluates the cardiorespiratory effects and tolerance of HSD solution infusion in patients undergoing cardiac valve surgery.
METHODS: This prospective, randomized, double-blind study compared clinical, laboratory, hemodynamic, and respiratory measurements, and fluid balance in 50 patients over a 48-hour period after cardiopulmonary bypass for cardiac valve surgery. Twenty-five patients received 4 mL/kg of HSD during 20 minutes before cardiopulmonary bypass (HSD group). The control group received the same volume of Ringer's solution (Ringer group).
RESULTS: Hospital mortality was zero. The HSD patients had a near zero fluid balance (6.5 ± 13.5 mL/Kg/48 hours), and the control patients had a positive balance (91.0 ± 33.7 mL/Kg/48 hours). Hemoglobin was similar in both groups, but more blood transfusions were necessary in the Ringer group (1.21 ± 1.28 vs 0.48 ± 0.59 units per patients). The HSD solution induced a higher cardiac index and left ventricular systolic work index postoperatively, and a lower systemic vascular resistance index until 6, 24, and 48 hours. Right ventricular systolic work index increased and pulmonary vascular resistance index decreased after HSD infusion. A better PaO2/FiO2 relation was observed at 1 and 6 hours postoperatively in the HSD group and was associated with a shorter extubation time (432.0 ± 123.6 vs 520.8 ± 130.2 minutes). Increased oxygen delivery index occurred in the HSD group. The HSD infusion was well tolerated as none of the patients experienced fluid overload or had left ventricular failure develop. No other complication attributable to the use of HSD solution was observed.
CONCLUSIONS: The HSD solution infusion in patients during cardiac valve surgery with cardiopulmonary bypass was well tolerated. Hemodynamic and respiratory functions improved and fluid balance was near zero during the first 48 hours as compared with a large positive balance in the control group. We conclude that HSD infusion is advantageous for patients undergoing cardiac valve surgery.
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