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The Annals of Thoracic Surgery, Vol 55, 1418-1424, Copyright © 1993 by The Society of Thoracic Surgeons
TM Sundt 3d, NT Kouchoukos, JE Saffitz, SF Murphy, TH Wareing and DJ Stahl
High-dose aprotinin was used in 20 patients undergoing primary or repeat
operations on the thoracic or thoracoabdominal aorta using cardiopulmonary
bypass and hypothermic circulatory arrest. The activated clotting times
immediately before the establishment of hypothermic circulatory arrest
exceeded 700 seconds in all but 1 patient. Three patients (15%) required
reoperation for bleeding. Seven patients died during hospitalization, and 5
had postmortem examination. Platelet-fibrin thrombi were present in
multiple organs including the coronary arteries of 4 patients with
myocardial infarction or failure, the pulmonary arteries of 2 patients, 1
of whom died of acute right ventricular failure, the brains of 2 patients
who sustained a stroke, and the kidneys of 4 patients, 3 of whom had
development of renal dysfunction. Renal dysfunction occurred in 13 patients
(65%), and all were 65 years of age or older. Five of these patients
required hemodialysis. Among 20 age-matched patients who had similar
operations without aprotinin, there was one hospital death (5%) from
myocardial infarction, and renal dysfunction developed in 1 patient (5%),
who did not require dialysis. None of these 20 patients required
reoperation for bleeding. Although aprotinin has been shown to reduce blood
loss in patients having cardiac operations employing cardiopulmonary
bypass, this benefit was not attained in this group of patients with
thoracic aortic disease in whom hypothermic circulatory arrest was used.
Use of aprotinin in elderly patients undergoing these procedures was
associated with an increased risk of renal dysfunction and failure, and of
myocardial infarction and death.
ARTICLES
Renal dysfunction and intravascular coagulation with aprotinin and hypothermic circulatory arrest
Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
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P. R. Feindt, S. Walcher, I. Volkmer, H. E. Keller, U. Straub, H. Huwer, U. T. Seyfert, T. Petzold, and E. Gams Effects of High-Dose Aprotinin on Renal Function in Aortocoronary Bypass Grafting Ann. Thorac. Surg., October 1, 1995; 60(4): 1076 - 1080. [Abstract] [Full Text]
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A. Wahba, A. Philip, M. Bauer, M. Kaiser, H. Aebert, and D. Birnbaum The blood saving potential of vortex versus roller pump with and without aprotinin Perfusion, September 1, 1995; 10(5): 333 - 341. [Abstract] [PDF]
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N. T. Kouchoukos, B. B. Daily, C. K. Rokkas, S. F. Murphy, S. Bauer, and N. Abboud Hypothermic Bypass and Circulatory Arrest for Operations on the Descending Thoracic and Thoracoabdominal Aorta Ann. Thorac. Surg., July 1, 1995; 60(1): 67 - 76. [Abstract] [Full Text]
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G. J. Despotis, J. H. Joist, D. Joiner-Maier, A. L. Alsoufiev, A. N. Triantafillou, L. T. Goodnough, S. A. Santoro, and D. G. Lappas Effect of Aprotinin on Activated Clotting Time, Whole Blood and Plasma Heparin Measurements Ann. Thorac. Surg., January 1, 1995; 59(1): 106 - 111. [Abstract] [Full Text]
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B. Blauhut, W. Harringer, P. Bettelheim, J. E. Doran, P. Spath, and P. Lundsgaard-Hansen Comparison of the effects of aprotinin and tranexamic acid on blood loss and related variables after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1083 - 1091. [Abstract] [Full Text]
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J. Boldt, B. Zickmann, E.Schindler, A. Welters, F. Dapper, and G. Hempelmann Influence of aprotinin on the thrombomodulin/ protein C system in pediatric cardiac operations J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1215 - 1221. [Abstract] [Full Text]
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M. Ranucci, M. Pavesi, E. Mazza, C. Bertucci, A. Frigiola, L. Menicanti, A. Ditta, A. Boncilli, and D. Conti Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique Perfusion, January 1, 1994; 9(5): 319 - 326. [Abstract] [PDF]
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