SAFETY AND EFFICACY OF APROTININ UNDER CONDITIONS OF DEEP HYPOTHERMIAAND CIRCULATORY ARREST

Aprotinin has been successfully used to reduce blood loss and blood pr oduct requirements in patients undergoing primary and reoperative card iac operations. Its safety and efficacy during profound hypothermia an d circulatory arrest have been questioned, however. A retrospective re view compared 24 patients who received aprotinin during complex aortic procedures under profound hypothermia and circulatory arrest with 24 age-matched patients undergoing similar procedures without aprotinin. Activated clotting time was maintained at longer than 500 seconds (kao lin activating agent) or longer than 750 seconds (celite). We observed no statistically significant difference in the incidence of neurologi c events (p not significant) or myocardial infarctions (p not signific ant), and there was a trend toward reduced in-hospital mortality rate in aprotinin-treated patients. A higher incidence of postoperative ren al dysfunction was encountered in aprotinin-treated patients. Aprotini n recipients had a significant reduction in requirements for postopera tive homologous erythrocytes (p = 0.01). We conclude that aprotinin ma y be safely and effectively used in patients undergoing deep hypotherm ia and circulatory arrest.