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Ann Thorac Surg 1995;60:549-550
© 1995 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Cardiac Surgery, Oxford Heart Center, Oxford Radcliffe Hospital, The John Radcliffe, Headington, Oxford OX3 9DU England

The first 20% of the full text of this article appears below.

See also page 544.

The importance of circuit priming volume, intraoperative hemodilution, and redistribution of fluid through the body compartments is understated. This article from Jansen and associates highlights the adverse physiologic effects of a large-volume circuit prime even in low-risk coronary bypass patients.

Hemodilution was a critical step in reducing the morbidity from a large priming volume of citrated donor blood. The degree of hemodilution is determined by bypass circuit volume and preoperative hemoglobin level. Blood transfusion may be needed to achieve a target hematocrit between 20% and 25%. Oxygen content is a linear function of hematocrit, but there is an exponential relationship between hematocrit and blood viscosity [1]. Consequently, a fractional fall in hematocrit produces an overall increase in oxygen transport. In contrast, cooling increases blood viscosity. In hypothermic perfusion hemodilution promotes microcirculatory flow so that reduced oxygen carrying capacity is offset by increased delivery [2]. This is partly due to dilution of fibrinogen down to a concentration that no longer causes the red cells to aggregate.

Different temperatures have their own optimal hematocrit. Optimal is . . . [Full Text of this Article]

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