Aprotinin and deep hypothermic circulatory arrest: There are no benefits even when appropriate amounts of heparin are given

Alessandro Parolari, Carlo Antona, Francesco Alamanni, Rita Spirito, Moreno Naliato, Piersilvio Gerometta, Vincenzo Arena, Paolo Biglioli

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate retrospectively the effect of 'high-dose' aprotinin on blood losses, donor blood requirements and morbid events on patients undergoing ascending aorta and/or aortic arch procedures with the employ of deep hypothermic circulatory arrest (HCA). Methods: During the period 1987-1994, 39 patients underwent a thoracic aorta procedure with the employ of circulatory arrest; of these 18 (46.2%) were operated on during the period 1990-1994 and were given aprotinin intraoperatively following the 'high-dose' protocol (group I), while 21 (53.8%) who underwent surgery during the years 1987-1989), did not receive intraoperative aprotinin and served as historical controls (group II). Twenty-seven (69.2%) patients were male, 18 (46.2%) were operated on on an emergency basis, 15 (38.5%) were acute type A dissections, and two (5.1%) were redo-operations. Circulatory arrest times were not significantly different between the two groups (40 ± 4 (S.E.) group I vs. 43 ± 4 min group II, P = 0.62) likewise cardiopulmonary bypass (CPB) times (181 ± 9 vs. 201 ± 20 mm, P = 0.74) and the amount of heparin administered (32056 ± 1435 vs. 31 691 ± 1935 IU, P = 0.56). Results: Postoperative blood loss was comparable between the two groups (1213 ± 243 (median 850) group I vs. 1528 ± 377 (median 880) ml group II, P = 0.87), as well as the number of units of donor blood transfused (9.4 ± 3.0 (median 6) vs. 9.9 ± 3.6, (median 5) P = 0.87), and revisions for bleeding (2/18, 11.1% vs. 3/21, 14.3%, P = 0.77). In-hospital mortality rate was not statistically different (5/18, 27.7% group I vs. 6/21, 28.6% group II, P = 0.92). There were no significant differences between the two groups in myocardial infarction (2/18, 11.1% vs. 0/21, 0%, P = 0.21), and postoperative renal failure rates (3/18, 16.7% vs. 2/21, 9.5%, P = 0.65). On the other hand, there was a trend towards an increased incidence of permanent neurological deficit (5/18, 27.7% group I vs. 1/21, 4.8% group II, P = 0.07) and towards a more complicated postoperative course (perioperative renal failure and/or myocardial infarction and/or neurological deficit either transient or permanent) (8/18, 44.4% group I vs. 4/21, 19% group II, P = 0.09) in group I patients. Forward stepwise logistic regression analysis, performed on the whole group of patients, identified chronic obstructive pulmonary disease (P = 0.010, Odds ratio (OR) = 5.7), aprotinin use (P = 0.017, OR = 5.1), and the number of units of blood collected intraoperatively by the cellsaver (P = 0.045, OR = 1.3/unit) as independent predictors of complicated postoperative course in the whole group of patients. CPB time (P = 0.040, OR = 1.0321/min), circulatory arrest time (P = 0.053, OR = 1.22/min), and overall donor blood units transfused (P = 0.067, OR =: 1.37/unit) emerged as independent risk factors for in-hospital mortality at multivariate analysis. Conclusions: Even when appropriate amounts of heparin are administered, 'high-dose' aprotinin probably is not an effective blood-sparing drug in deep HCA. Aprotinin should be employed cautiously in this clinical setting because of its possible correlation with an increased rate of postoperative morbid events.

Original languageEnglish
Pages (from-to)149-156
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume11
Issue number1
DOIs
Publication statusPublished - Jan 1997

Keywords

  • Aprotinin
  • Circulatory arrest
  • Deep hypothermia
  • Unfavourable events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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