Dj. Goldstein et al., SAFETY OF REPEAT APROTININ ADMINISTRATION FOR LVAD RECIPIENTS UNDERGOING CARDIAC TRANSPLANTATION, The Annals of thoracic surgery, 61(2), 1996, pp. 692-695
Background. Anecdotal reports of allergic and anaphylactic reactions a
fter aprotinin therapy have raised concern that its repeat use may be
associated with substantial morbidity. Methods. To address this concer
n, we reviewed our experience with all patients who underwent implanta
tion of a left ventricular assist device and subsequent cardiac transp
lantation with perioperative use of aprotinin. Results. Twenty-three p
atients received full-dose aprotinin during left ventricular assist de
vice implantation and subsequent cardiac transplantation. All patients
tolerated primary exposure to aprotinin without complication. One epi
sode of anaphylaxis after secondary exposure was treated with rapid in
stitution of cardiopulmonary bypass. Although renal dysfunction was ob
served shortly after cardiac transplantation in 30.4% of patients, the
effect was transient and occurred in the presence of cyclosporine. Th
e one perioperative death after secondary exposure was unrelated to bl
eeding complications. No clinically evident thromboembolic events were
documented. Conclusions. Primary and secondary exposure to aprotinin
during operation with cardiopulmonary bypass is associated with limite
d intraoperative blood use, a low incidence of transient renal dysfunc
tion and anaphylaxis, a rare need of reoperation for bleeding, and no
clinical thromboembolic events.