SAFETY OF REPEAT APROTININ ADMINISTRATION FOR LVAD RECIPIENTS UNDERGOING CARDIAC TRANSPLANTATION

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.