Limited intentional normovolemic hemodilution: ST-segment changes and use of homologous blood products in patients with left main coronary artery stenosis

Objective : To assess and compare the effects of limited intentional normovolemic hemodilution (LINH) on ST-segment changes and to evaluate the need for homologous blood products. Design : Prospective, randomized study. Setting : University hospital. Participants : Seventy-one patients with left main stenosis scheduled for semi-urgent coronary artery bypass grafting. Interventions : Patients in grou A ( n = 39) underwent LINH during the prebypass period until a hematocrit of 34% was obtained. Simultaneously succinyl-linked gelatin was infused. In group B ( n = 32), no hemodilution was performed. Mean arterial pressure and central venous pressure were kept as constant as possible. During the postbypass period, autologous blood was retransfused. The need for homologous blood products was noted intraoperatively and postoperatively. Measurements and Main Results : ST-segment analysis of lead II and chest lead was continuously performed in all patients. An ST-segment change was defined as a decrease from baseline of 1.0 mm (−0.1 mV). The appearance and degee of ST-segment depression were comparable in both groups (group A: 7 patients −0.1 mV, 1 patient −0.2 mV; group B: 5 patients −0.1 mV; 3 patients −0.2 mV). In group A, ST-segment depression occurred during and after the blood exchange. However, the mean duration of the ST-segment depression (group A: 33 ± 18 minutes; group B: 20 ± 10 minutes) was comparable between groups. In group A, a mean of 750 mL ± 245 mL of blood was obtained. Total blood loss was significantly higher in group B p< 0.052); 25 patients in group A (64%) and 12 patients in group B (38%) did not require homologous blood products ( p< 0.03). Intraoperatively, only the need for packed red cells was greater in group B ( p < 0.04). Postoperatively, the use of homologous blood products is higher than intraoperatively p < 0.02). Conclusions : LINH performed in patients with left main stenosis, scheduled for semi-urgent coronary bypass, is not associated with increases in frequency, degree, or duration of ST-segment changes. This procedure allowed a reduction in the number of patients who received homologous blood products.