Cardiac Surgery

Key points

  • Both pre- and postoperative hypoalbuminaemia are associated with adverse outcomes, such as increased incidence of AKI in children and an increased mortality
  • Albumin is 5 times more effective than saline as plasma volume
  • Albumin versus HES reduced mortality after CABG
  • Discontinuation of HES in one Canadian institution led to a shorter hospital stay and reduced risk of red blood cell, plasma and platelet transfusion
  • There are significant differences in the effects on blood coagulation parameters between different fluid therapies, with prolonged clot formation and reduced clot firmness with HES

Cardiac surgery including coronary-artery bypass grafting (CABG) is either performed using cardiopulmonary bypass (on-pump CABG), or without cardiopulmonary bypass (off-pump CABG) (Shroyer et al., 2009).

Appropriate fluid management in cardiac surgery patients is critical, but the choice of colloid or crystalloid – and which colloid – is still actively discussed (Schumacher & Klotz, 2009; Shaw & Raghunathan, 2013).