Most cardiac surgery procedures requires the use of heart-lung machine. The heart-lung machine circuit needs to be filled with a fluid before connecting it to the patients circulation. This is called priming and is accomplished by filling the circuit with a solution used for fluid replacement. The circuit in our institution requires 1100 mL to be filled.
The body has several mechanisms with the purpose to maintain its state of balance. When a large amount of clear solution suddenly enters the blood stream this balance can be altered. The goal of this clinical trial is to investigate different priming solutions in the heart-lung machine circuit. The main questions it aims to answer are:
How do different priming solutions alter the acid-base balance, osmolality and electrolytes which reflects the body's water balance for patients undergoing cardiac surgery with the use of heart-lung machine?
There will be 4 different groups:
1. Ringer-Acetate, 1100 mL / no addition 2. Ringer-Acetate, 1100 mL + 80 mmol sodium chloride (NaCl) 3. Ringer-Acetate, 1100 mL + 160 mmol NaCl 4. Plasmalyte, 1100 mL / no addition Blood samples will be taken before, during and after surgery, post operative day 1 and 4 to analyze acid-base balance, electrolytes, and plasma osmolality. Urine output and hydration status will also be collected until post operative day 1. After 3 months, a blood sample will be taken for analysis of electrolytes and kidney function.
Patients 18 years and above
Undergoing coronary artery bypass graft (CABG) surgery as single surgery
Undergoing aortic valve replacement (AVR) as single surgery (AtriClip is allowed)
Given consent to participate, both verbal and written
Subnormal heart function (defined as an ejection fraction <45%), and no signs of heart failure (edema).
Body weight <60 kg or >120 kg
Preoperative hemoglobin <120 g/L,
Subnormal kidney function (defined as GFR <30 ml/min),
Parallel
Ringer's Acetate 80
Diagnostic testCardiopulmonary bypass circuit will be primed with Ringer's Acetate 1100 ml and 80 mmol NaCl
Plasmalyte
Diagnostic testCardiopulmonary bypass circuit will be primed with Plasmalyte 1100 ml, no addition.
Ringer's Acetate no add
Diagnostic testCardiopulmonary bypass circuit will be primed with Ringer's Acetate 1100 ml no addition
Ringer's Acetate 160
Diagnostic testCardiopulmonary bypass circuit will be primed with Ringer's Acetate 1100 ml and 160 mmol NaCl
Acid Base Balance
This study uses blood samples that are taken at predefined timepoints
Sodium concentration
This study uses blood samples that are taken at predefined timepoints
Osmolality
This study uses blood samples that are taken at predefined timepoints
Chloride, magnesium -and potassium concentrations
This study uses blood samples that are taken at predefined timepoints
Urine output
Production of urine will be studied during cardiac operation and post operative
Kidney function
Creatinine-and urea concentration, glomerular filtration rate
Neurological outcome
S-100, a prognostic biomarker used for assessing brain injury
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