USE OF APROTININ IN LVAD RECIPIENTS REDUCES BLOOD-LOSS, BLOOD USE, AND PERIOPERATIVE MORTALITY

Aprotinin, a bovine protease inhibitor, has been used extensively in p atients undergoing cardiac surgical procedures in an effort to minimiz e blood loss and prevent the complications associated with blood repla cement. We sought to evaluate the effect of aprotinin on postoperative blood loss, renal function, and the incidence of right ventricular fa ilure in patients undergoing placement of a TCl Heartmate left ventric ular assist device as a bridge to cardiac transplantation. Retrospecti ve data analysis in 142 patients (42 receiving aprotinin and 100 untre ated) demonstrated that the use of aprotinin was associated with a sig nificant decrease in postoperative blood loss (p = 0.019) and in the i ntraoperative packed red blood cell transfusion (p = 0.019) and total blood product (p 0.016) requirements. A transient, yet significant, in crease in the postoperative creatinine level in the aprotinin group (p = 0.0006), but not in blood urea nitrogen level (p = 0.22), was noted . Interestingly, we noted an association between blood loss and the su bsequent development of right ventricular failure; patients who requir ed a right ventricular assist device bled significantly more than did those who did not suffer right ventricular failure (p = 0.02). Additio nally, aprotinin recipients benefited by a reduction of nearly one hal f in the incidence of the need for a right ventricular assist device. The incidence of perioperative mortality was reduced in those receivin g aprotinin compared with that in untreated patients, (p 0.05). We con clude that aprotinin is safe and effective in decreasing postoperative blood loss and intraoperative blood product requirements, and in redu cing perioperative mortality in patients undergoing left ventricular a ssist device placement as a bridge to cardiac transplantation.