APROTININ IN CHILDREN UNDERGOING REPAIR OF CONGENITAL HEART-DEFECTS

Background. Aprotinin use in adults is increasing, and its use in chil dren has recently been reported. Methods. The efficacy of aprotinin in children was tested in 80 children. Patients were in four groups: reo perations (59), neonates (8), extremely cyanotic children (6), and oth er complex repairs (7). The results were compared with those of 55 con trol infants and children: reoperations (25), neonates (10), cyanotic (10) and complex (10). Treatment groups were identical in age, sex rat io, cross-clamp time, and bypass time. Results. Patients treated with aprotinin had a significant reduction in chest tube drainage (16.5 +/- 9.8 versus 33.4 +/- 22.1 mL degrees kg(-1)degrees h(-1); p < 0.001) a nd time to skin closure (64.2 +/- 23.7 versus 80.1 +/- 24.6 minutes; p < 0.001). Transfusion requirements were decreased in aprotinin-treate d patients (4.2 +/- 3.4 versus 6.7 +/- 5.2 donors; p < 0.001). All of the control patients were exposed to at least one donor, whereas 10/80 (12.5%) of the aprotinin-treated group had no blood use (p < 0.006). There were no cases of renal insufficiency or allergic reactions in ch ildren receiving aprotinin. Three patients had thrombotic episodes: 2 superior vena caval problems and a lower extremity deep venous thrombo sis. There were 3 cases of mediastinitis in the aprotinin group versus none in control patients (p < 0.05). Conclusions. We conclude aprotin in is an effective means of reducing bleeding, operating time, and don or exposure in infants and children. An increased rate of thrombosis a nd possibly mediastinitis are potential problems.