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Ann Thorac Surg 1996;62:1329-1335
© 1996 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Aprotinin Improves Outcome of Single-Ventricle Palliation

James S. Tweddell, MD, Stuart Berger, MD, Peter C. Frommelt, MD, Andrew N. Pelech, MD, David A. Lewis, MD, Raymond T. Fedderly, MD, Michele A. Frommelt, MD, Terrence S. McManus, Ccp, Kathleen A. Mussatto, RN, Maryanne W. Kessel, RN, S. Bert Litwin, MD

Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Background. Elevation of pulmonary vascular resistance as a consequence of cardiopulmonary bypass may lead to failure of single-ventricle palliation. We reviewed our experience with aprotinin, a nonspecific serine protease inhibitor, to determine whether it could ameliorate the inflammatory effects of cardiopulmonary bypass and improve outcome of single-ventricle palliation.

Methods. Forty-six consecutive patients undergoing single-ventricle palliation using cardiopulmonary bypass were reviewed retrospectively. Aprotinin was used in 8 of 30 bidirectional cavopulmonary shunt and 10 of 16 Fontan procedures.

Results. Aprotinin use was associated with a decrease in the early postoperative transpulmonary gradient among patients undergoing Fontan and bidirectional cavopulmonary shunt procedures. The bidirectional cavopulmonary shunt aprotinin group had a higher oxygen saturation and a decrease in quantity and duration of thoracic drainage. Among patients receiving aprotinin there were no episodes of mediastinitis, thrombus formation, or renal failure.

Conclusions. Aprotinin use in single-ventricle palliation was associated with decreased transpulmonary gradient and increased oxygen saturation consistent with decreased pulmonary vascular resistance. This retrospective study suggests that aprotinin has a favorable impact on the early postoperative course of single-ventricle palliation.


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Discussion
Ann. Thorac. Surg. 1996 62: 1335-1336. [Extract] [Full Text]



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