[Isovolemic hemodilution in patients with coronary heart disease]

In the age of cellsavers patients suffering from coronary heart disease are diluted to a hematocrit of 20% or even less during a surgical intervention in the coronaries and they leave the operating room with a hematocrit of 30%. On the other hand, a hemodilution to a level of 30% in patients with coronary heart disease represents a contraindication due to the limited coronary reserve. On the occasion of the collection of autologue blood, before vascular surgery or for therapeutical hemodilution, the hematocrit was reduced from 45 to 35% by means of an isovolemic hemodilution with 500 ml of Haes 200/0.5 10% in 50 patients. In the load-ECG the pressure X frequency-product and the dyspnoe decreased significantly. The microcirculation in the nailfold and the systemical blood fluidity increased significantly. As in 22% of the patients a deterioration was stated, we propose to dilute all the patients who have to undergo a coronary vessel operation without exclusion criteria once isovolemically and to stress them before and afterwards. The patients having a clinical defict should be diluted intraoperatively only to 30% and postoperatively not under 35%.