Knutson JE, et. al. Anesth Analg 2000; 90:801-7

Reviewed by: R. Prasad, MD

Conclusions:
-Hetastarch in primary cardiac surgery with CPB may increase bleeding and transfusion requirements

Comments:
-The recently released version of hetastarch contains calcium, and I believe is reported to have fewer problems with coagulopathy. Calcium levels were not recorded in this study ... would this have made any difference?

Study:
-Retrospective chart review
-Primary CABG, valve repair, of valve replacement requiring CPB
-444 cases. 234 with, 210 without hetastarch
-Blood loss 0-4h postop
Heta        515 +/- 336 ml
No heta   377 +/- 244 ml
-Blood loss 0-24h postop
Heta        1283 +/- 686 ml
No heta   923 +/- 473 ml
Heta also had higher cryo, FFP, and platelet requirements.
Heta Group:
-nearly all received < 20ml/kg
-higher frequency preop anticoagulation
-lower temp on CPB (28 deg vs. 31)
-longer post-CPB OR time
-higher aPTT preop
However, multi-variate analysis still suggested heta associated with increased transfusion.