Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery

Influence of hemodilution on the development of complicationsin the early postoperative period in patients with cyanoticcongenital heart diseases operated with cardiopulmonary bypass

Authors: A.P. Chislova, A.A. Kupryashov, D.V. Kovalev, L.Yu. Mokrinskaya, T.O. Astrakhantseva, M.M. Rybka

Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.


UDC: 616.12-007-053.1-089.8-78-089.168.1:615.38

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (3): 198-206

Quote as: Chislova A.P., Kupryashov A.A., Kovalev D.V., Mokrinskaya L.Yu., Astrakhantseva T.O., Rybka M.M. Influence of hemodilution on the development of complications in the early postoperative period in patients with cyanotic congenital heart diseases operated with cardiopulmonary bypass. Clinical Physiology of Circulation. 2018; 15 (3): 198–206 (in Russ.). DOI: 10.24022/1814-6910-2018-15-3-198-206

Received / Accepted:  20.02.2018/21.03.2018

Full text:  


Objective. To identify the impact of hemodilution on intraoperative hemorrhage and development of organ dysfunction in the early postoperative period in patients with cyanotic congenital heart diseases (СHD) underwent surgery with cardiopulmonary bypass (CPB).

Material and methods. The study included 104 patients. There were compared two groups with a cyanotic CHD and noncyanotic CHD with right ventricular outflow tract obstruction. There were determined the concentration of hemoglobin and hematocrit (before surgery, at perfusion, and at admission to the intensive care unit), blood transfusion (ml/kg) and the hemostatic system parameters. ROC analysis was used to study the effect of hemodilution on the development of early postoperative complications.

Results. In the groups with cyanotic CHD and noncyanotic CHD, statistically significant differences were found: degree of hemodilution (р<0.01), number of complications (р<0.01), hemorrhage (р=0.025) and in terms of stay in the intensive care unit (р=0.03). In the group of cyanotic patients, there are: a significant decrease in the number of platelets, an increase in activated partial thromboplastin time, a greater (in comparison with the group without cyanosis) an increase in international normalized ratio, a decrease in the concentration of fibrinogen. Hemodilution (the ratio of hematocrit at the time of perfusion to the initial one) may be a predictor of the development of complications, AUC=0.61, cut-off value 62%.

Conclusion. Patients with cyanosis are at greater risk of developing early postoperative complications compared with noncyanotic CHD, half of them are associated with intraoperative hemorrhage. With an increase in the degree of hemodilution, the harm from possible dilution coagulopathy is greater than the benefit of improving rheology.


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About Authors

  • Chislova Anna Pavlovna, Anesthesiologist-Intensivist;
  • Kupryashov Aleksey Anatol'evich, Dr. Med. Sc., Head of Blood Transfusion Department;
  • Kovalev Dmitriy Viktorovich, Dr. Med. Sc., Leading Researcher, Cardiovascular Surgeon;
  • Mokrinskaya Lyudmila Yur'evna, Cardiovascular Surgeon
  • Astrakhantseva Tat'yana Olegovna, Dr. Med. Sc., Leading Researcher, Cardiologist;
  • Rybka Mikhail Mikhaylovich, Dr. Med. Sc., Head of Department of Anesthesiology and Intensive Care;

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