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Six per cent hydroxyethyl starch was compared prospectively with 25% albumin as the oncotic component of cardiopulmonary pump prime solutions. Oncotic pressure of the pump prime solution was measured, and serum oncotic pressure (OP) values were recorded at designated times during the perioperative period. Changes in these values were compared with alterations in extravascular lung water (EVLW), the serum oncotic pressure-pulmonary artery occluded pressure gradient and the alveolar-arterial difference in oxygen tension [D(A-a)O2] before and immediately after bypass and in the surgical intensive care unit after operation. A significant increase in EVLW was associated with a decrease in serum OP and an increase in D(A-a)O2 immediately after bypass. However, EVLW values had returned to baseline by time of determination in the surgical intensive care unit. Cost savings may be realized by the use of hydroxyethyl starch in this setting if average wholesale price data are representative of costs throughout the country.