APROTININ IMPROVES OUTCOME OF SINGLE-VENTRICLE PALLIATION

Background. Elevation of pulmonary vascular resistance as a consequenc e of cardiopulmonary bypass may lead to failure of single-ventricle pa lliation. We reviewed our experience with aprotinin, a nonspecific ser ine protease inhibitor, to determine whether it could ameliorate the i nflammatory effects of cardiopulmonary bypass and improve outcome of s ingle-ventricle palliation. Methods. Forty-six consecutive patients un dergoing single-ventricle palliation using cardiopulmonary bypass were reviewed retrospectively. Aprotinin was used in 8 of 30 bidirectional cavopulmonary shunt and 10 of 16 Fontan procedures.Results. Aprotinin use was associated with a decrease in the early postoperative transpu lmonary gradient among patients undergoing Fontan and bidirectional ca vopulmonary shunt procedures. The bidirectional cavopulmonary shunt ap rotinin group had a higher oxygen saturation and a decrease in quantit y and duration of thoracic drainage. Among patients receiving aprotini n there were no episodes of mediastinitis, thrombus formation, or rena l failure. Conclusions. Aprotinin use in single-ventricle palliation w as associated with decreased transpulmonary gradient and increased oxy gen saturation consistent with decreased pulmonary vascular resistance . This retrospective study suggests that aprotinin has a favorable imp act on the early postoperative course of single-ventricle palliation.