Effects of priming without plasma during cardiopulmonary bypass on postoperative recovery and coagulation functions of cyanotic congenital heart diseases in children

Objective To explore the efficiency and safety of 4％ succinylated gelatin as priming solution instead of fresh frozen plasma during cardiopulmonary bypass for cyanotic heart diseases in children.Methods A total of eighty cyanotic infant patients undergoing heart surgery with extracorporeal circulation (ECC) were randomly divided into two groups (n =40 each group).Either 4％ succinylated gelatin (gelatin group) or fresh frozen plasma (plasma group) was primed for ECC respectively.Rapid-thromboelastography (r-TEG) was performed after anesthesia induction and protamine administration.The postoperative parameters of renohepatic function,bleeding volume,blood product dosage and clinical recovery time were recorded.And the association between characteristics,hemostatic variables and postoperative blood loss volume were also analyzed.Results No patient developed obvious renal or liver dysfunction.Compared with gelatin group (1 355 ± 338 mg/L),plasma group showed a significantly elevated level of fibrinogen (1 672 ± 390 mg/L) (P =0.012).However,there was no clinical efficiency of adding plasma in ECC circuit since bleeding volume(21.5 ± 8.8 vs 22.9 ± 8.5,P =0.371),blood product dosage(PLT 1.0 u vs 1.0 u P =0.253;RBC 1.0 u vs 1.5 u,P =0.483 ; FFP 33.9 ± 10.9 ml/kg vs 35.4 ± 11.8 ml/kg,P =0.268) and clinical recovery time(ventilation time 39.3 h vs 37.5 h,P =0.256; ICU stay 61.0 vs 60.5 h,P =0.264;hospitalization time 14 vs 14 d,P =0.430) were comparable between two groups.The maximal amplitude (MA) after bypass was correlated with early blood loss volume after surgery.Conclusions Replacement of plasma with artificial colloid-like gelatinin for ECC circuit priming is both safe and effective for infants with congenital heart disease.And r-TEG may be used as a tool for evaluating hemostatic function after heart surgery in infant patients. Key words: Extracorporeal circulation;  Heart disease, congenital;  Blood coagulation;  Thromboelastography