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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 284-296, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MJ London, M Franks, ED Verrier, SH Merrick, J Levin and DT Mangano
Ten percent pentastarch is a low-molecular-weight hydroxyethyl starch with
greater oncotic pressure and shorter intravascular persistence than 6%
hetastarch. To evaluate its safety and efficacy as a component of
cardiopulmonary bypass priming solution, we prospectively studied 90
patients undergoing coronary artery bypass grafting or valve replacement
necessitating cardiopulmonary bypass (bubble oxygenator and moderate
systemic hypothermia). Sixty patients were randomized to receive 75 gm of
either 10% pentastarch (group P) or 25% albumin (group A), and 30 patients
received lactated Ringer's solution alone (group C). Intravascular colloid
osmotic pressure during cardiopulmonary bypass was highest with either of
the colloid primes (15-minute measurement: group P, 15.7 +/- 2.2 mm Hg
(mean +/- standard deviation); group A, 15.2 +/- 2.0 mm Hg; group C, 11.3
+/- 1.7 mm Hg; p less than 0.05, groups P and A compared with group C).
This was associated with a lower volume requirement during cardiopulmonary
bypass to maintain the venous reservoir (group P, 333 +/- 318 ml; group A,
483 +/- 472 ml; group C, 1332 +/- 1013 ml; p less than 0.05, groups P and A
compared with group C). Urine output during cardiopulmonary bypass was
similar in each group. Net intraoperative fluid balance was lowest in the
colloid groups (groups P and A, 5.7 +/- 1.4 L; group C, 6.9 +/- 1.3 L; p
less than 0.05, groups P and A compared with group C). Cardiac index
shortly after weaning from cardiopulmonary bypass was greatest in group P
(group P, 3.2 +/- 0.9; group A, 2.8 +/- 0.8; group C, 2.7 +/- 0.6
dyne.sec.cm-5; p less than 0.05, group P compared with group C). Changes in
alveolar-arterial oxygen gradients, shunt fraction, and effective
compliance were similar in all groups. During cardiopulmonary bypass,
pentastarch appeared to cause the greatest degree of hemodilution, as
suggested by the lowest hemoglobin, factor VII and IX levels and platelet
count. The activated partial thromboplastin time was significantly
prolonged during and immediately after cardiopulmonary bypass in group P
relative to groups A and C (p less than 0.05), although there were no
significant differences in the activated clotting time before
cardiopulmonary bypass, during cardiopulmonary bypass, or after heparin
neutralization. As well, clinical indices of hemostasis, including
mediastinal drainage, red cell, platelet, and fresh frozen plasma
requirements, and reoperation for excessive postoperative bleeding, were
similar. We conclude that pentastarch, when used in cardiopulmonary bypass
prime, is as safe as either albumin or Ringer's solution alone.(ABSTRACT
TRUNCATED AT 400 WORDS)
ARTICLES
The safety and efficacy of ten percent pentastarch as a cardiopulmonary bypass priming solution. A randomized clinical trial
Department of Anesthesia, University of California, San Francisco.
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