Journal of cardiac surgery
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Albumin is commonly used as a volume expander in cardiopulmonary bypass (CPB) prime. Pentastarch, a low molecular weight hetastarch, may provide similar efficacy at decreased cost but is known to alter coagulation profiles. Infectious concerns forced the temporary withdrawal of albumin in our institution. Therefore we evaluated pentastarch as an alternative with regards to perioperative hemostasis and blood loss. ⋯ The diminished coagulability associated with this dose of pentastarch resulted in increased postoperative bleeding. However, with recirculation of shed mediastinal blood, there was no net increase in blood loss. In this setting, pentastarch may serve as a suitable alternative to albumin.
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The traditional approach to postcardiotomy shock includes inotropic support followed by the application of an intra-aortic balloon pump (IABP). Consideration toward insertion of a ventricular assist device (VAD) becomes necessary when these maneuvers fail to restore hemodynamic stability. The definition of maximal inotropic support, however, is lacking such that a standard formula for VAD insertion remains problematic. The purpose of this paper is to define the pharmacological thresholds for VAD implantation in the setting of postcardiotomy cardiogenic shock. ⋯ Hospital mortality correlates with the number and level of inotropic support necessary to separate from CPB following adult open heart surgery. The application of a standard pharmacological formula together with hemodynamic criteria for VAD insertion after postcardiotomy cardiogenic shock results in earlier insertion, lower incidence of postoperative MOSF, and improved wean and discharge rates.