European Journal of Cardio-Thoracic Surgery, Vol 11, 373-378, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Aprotinin in aortic surgery requiring profound hypothermia and circulatory arrest
SJ Rooney, D Pagano, G Bognolo, C Wong and RS Bonser
Cardiothoracic Surgical Unit, Queen Elizabeth Hospital, Birmingham, UK.
OBJECTIVE: The use of aprotinin in cardiac surgery to improve haemostasis
and reduce blood loss particularly in patient groups at increased risk of
bleeding is well established. Previous retrospective studies in profound
hypothermic surgery have highlighted concerns that in this circumstances
aprotinin may paradoxically cause increased bleeding and intravascular
thrombosis. We therefore adopted a modified protocol for administering
aprotinin, which was not started until cardiopulmonary bypass had been
reinstituted after circulatory arrest. METHODS: Between April 1993 and June
1995, 45 patients underwent 46 thoracic aortic procedures which required
hypothermic circulatory arrest; 25 of these were emergencies. All of these
patients received aprotinin. RESULTS: There were five deaths (10.8%) in
hospital. Two patients with preoperative oliguric renal failure required
postoperative dialysis, and a further six (13%) developed transient renal
dysfunction with complete recovery. Two patients suffered postoperative
stroke; one from embolisation of a severely diseased aorta, while the other
had signs of an acute evolving stroke before surgery. None of the patients
suffered acute Q-wave perioperative myocardial infarction. The mean blood
loss was 575 ml in the first 12 h, with a mean postoperative transfusion
requirement of 1 U blood. CONCLUSIONS: We cannot implicate aprotinin in
increased postoperative blood loss, renal dysfunction or mortality when
used with hypothermic circulatory arrest according to this protocol.
Elucidating the role of aprotinin in hypothermic circulatory arrest
requires a randomised prospective study.
