Changes in the plasma protease systems during open-heart surgery with dextran vs. Ringer acetate as priming solution

Area of Science:

• Cardiovascular Surgery
• Hemostasis and Thrombosis
• Biochemistry

Background:

• Cardiopulmonary bypass (CPB) involves hemodilution, potentially affecting plasma protease systems.
• Priming solutions are critical for CPB management and patient outcomes.
• Understanding the impact of different priming solutions on protease systems is essential for optimizing CPB protocols.

Purpose of the Study:

• To investigate the influence of two distinct CPB priming solutions on plasma protease systems.
• To compare the effects of dextran-based versus Ringer's acetate-based priming solutions.
• To assess the clinical significance of any observed changes in protease activity.

Main Methods:

• A comparative study involving 20 patients undergoing elective coronary artery bypass grafting.
• Patients were divided into two groups: one receiving a dextran-containing priming solution and the other Ringer's acetate.
• Plasma protease systems (kallikrein-kinin, fibrinolytic, coagulation) were analyzed using chromogenic substrate assays before, during, and after CPB.

Main Results:

• A slightly greater decrease in antiplasmin activity was noted in the dextran group compared to the Ringer's acetate group post-CPB.
• This difference in antiplasmin activity was not statistically significant and deemed clinically insignificant.
• No other statistically significant intergroup differences were observed in the measured components of the kallikrein-kinin, fibrinolytic, or coagulation systems.

Conclusions:

• Both dextran and Ringer's acetate priming solutions appear to have a comparable and minimal impact on plasma protease systems during cardiopulmonary bypass.
• The observed minor changes in antiplasmin activity do not suggest a clinically relevant difference between the two priming solutions.
• Further research may explore other aspects of protease system modulation or long-term patient outcomes.