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

• Published in: European journal of cardio-thoracic surgery 1997-01, Vol.11 (1), p.149-156
• Main Authors: PAROLARI, A, ANTONA, C, ALAMANNI, F, SPIRITO, R, NALIATO, M, GEROMETTA, P, ARENA, V, BIGLIOLI, P
• Format: Article
• Language: English
• Subjects: Aged; Aneurysm, Dissecting - blood; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - blood; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aprotinin - administration & dosage; Biological and medical sciences; Blood Loss, Surgical - physiopathology; Blood Loss, Surgical - prevention & control; Blood Transfusion; Blood. Blood coagulation. Reticuloendothelial system; Cause of Death; Dose-Response Relationship, Drug; Female; Heart Arrest, Induced - methods; Heparin - administration & dosage; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Postoperative Complications - blood; Postoperative Complications - mortality; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Risk Factors; Survival Rate
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(96)01022-6

OBJECTIVE: To evaluate retrospectively the effect of 'high-dose'aprotinin on blood losses, donor blood requirements and morbid events onpatients undergoing ascending aorta and/or aortic arch procedures with theemploy of deep hypothermic circulatory arrest (HCA). METHODS: During theperiod 1987-1994, 39 patients underwent a thoracic aorta procedure with theemploy of circulatory arrest; of these 18 (46.2%) were operated on duringthe period 1990-1994 and were given aprotinin intraoperatively followingthe 'high-dose' protocol (group I), while 21 (53.8%) who underwent surgeryduring the years 1987-1989, did not receive intraoperative aprotinin andserved as historical controls (group II). Twenty-seven (69.2%) patientswere 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 twogroups (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 comparablebetween 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 ofdonor 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 nosignificant 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 atrend 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 morecomplicated postoperative course (perioperative renal failure and/ormyocardial infarction and/or neurological deficit either transient orpermanent) (8/18, 44.4% group I vs. 4/21, 19% group II, P = 0.09) in groupI patients. Forward stepwise logistic regression analysis, performed on thewhole 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 th