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Effect of Hydroxyethyl Starch Priming on the Systemic Inflammatory Response and Lung Edema after Cardiopulmonary Bypass in a Rat Model

Fujii, Yutaka*†; Tanabe, Takayuki; Yamashiro, Tsubasa§; Shirai, Mikiyasu; Takewa, Yoshiaki; Tatsumi, Eisuke

doi: 10.1097/MAT.0000000000000543
Clinical Cardiovascular

Cardiopulmonary bypass (CPB) preserves patients’ lives during open heart surgery by providing sufficient oxygen delivery and blood supply to vital organs. However, previous studies have suggested that the interaction of hemodilution and vascular hyperpermeability induces tissue edema and an inflammatory response during CPB. In this study, we hypothesized the suppression of the systemic inflammatory response and tissue edema during CPB by a plasma substitute (hydroxyethyl starch [HES]). Rats (450–500 g) were divided into a SHAM group (n = 5), a Ringer’s acetate CPB group (n = 7), and an HES CPB group (n = 7). In the Ringer’s acetate group, the CPB circuit was primed with Ringer’s acetate solution, and in the HES CPB group, it was primed with HES formulation (6% HES 130/0.4). Blood samples were collected before (baseline) and 30, 60, 90 and 120 min after initiation of CPB. Plasma cytokine levels of tumor necrosis factor-α, interleukin (IL)-6, and IL-10, and biochemical markers (lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine, liver-type fatty acid–binding protein, and colloid osmotic pressure [COP]) were measured before and 30, 60, 90, and 120 min after the initiation of CPB. In the Ringer’s acetate CPB group, the inflammatory cytokines and biochemical markers increased significantly during CPB compared with the SHAM group, but such increases were significantly suppressed in the HES CPB group. In addition, during CPB, it was possible to preserve normal plasma COP in the HES CPB group. The data suggest that 6% HES 130/0.4 is effective for suppressing the inflammatory response during CPB.

From the *Department of Clinical Engineering and Medical Technology, Niigata University of Health and Welfare, Niigata, Japan; Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan; Department of Clinical Engineering, Sakakibara Heart institute, Fuchu, Japan; §Department of Clinical Engineering, Seikei-kai Chiba Medical Center, Chiba, Japan; and Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.

Submitted for consideration July 2016; accepted for publication in revised form January 2017.

Disclosure: The authors have no conflicts of interest to report.

Supported by JSPS KAKENHI Grant-in-Aid for Young Scientists B (Grant No: 15K21692).

Correspondence: Yutaka Fujii, Department of Clinical Engineering and Medical Technology, Niigata University of Health and Welfare, Niigata, Japan. Email:

Copyright © 2017 by the American Society for Artificial Internal Organs