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Maintaining vascular barrier competence, preventing interstitial edema, and keeping microcirculation intact is crucial to achieve an optimal outcome in cardiopulmonary bypass surgery (CPB). Blood contact with roller pumps and foreign surfaces during CPB induces shear stress and a pressure drop across the pump boot that leads to transient systemic activation of the inflammatory and hemostatic systems. Moreover, patients after CPB often need volume resuscitation using the smallest possible amount of colloid solution because of fluid overload. For this purpose, human-derived albumin may be preferred over synthetic colloids because CPB priming with albumin preserves oncotic pressure, prevents platelet adhesion, and likely induces less consumption of coagulation factors. In patients with increased bleeding or renal failure, albumin is a safe alternative because of its minimal side effects. Large, randomized clinical trials comparing the benefit of albumin versus other fluids are warranted in the future to define albumin’s distinct role in select high-risk surgical populations. [ABSTRACT FROM PUBLISHER]

We aimed to assess the effect of two different modalities for administering similar doses of tranexamic acid on bleeding following primary elective valve replacement cardiac surgery. In a double-blinded, prospective, placebo-controlled design, 209 patients scheduled for aortic, mitral or combined valve replacement were randomized to three groups: one placebo and two treatment groups applying different modalities of tranexamic acid administration (bolus injection of 30 mg/kg vs. continuous infusion). Blood loss up until removal of chest tubes was the primary outcome measure; also recorded and assessed were blood products transfused, need of resternotomy and thrombogenic complications. All groups were comparable at baseline. Blood loss and excessive bleeding were greater in the placebo group than in either treatment group ( P < 0.001). Trends toward transfusion differences between groups did not reach statistical significance. No differences in thromboembolic complications, morbidity or mortality were found. In valve replacement cardiac surgery, the use of either method for administering similar doses of tranexamic acid leads to a similarly significant reduction in postoperative mediastinal bleeding, although transfusion needs remained unchanged compared with the placebo group. [ABSTRACT FROM AUTHOR]