THE EFFECT OF HIGH-DOSE APROTININ AND OTHER FACTORS ON BLEEDING AND REVISIONS FOR BLEEDING IN ADULT CORONARY AND VALVE OPERATIONS - AN ANALYSIS OF 2190 PATIENTS DURING A 5-YEAR PERIOD (1987-1991)

We retrospectively evaluated risk factors for postoperative bleeding a nd for revisions due to bleeding in 2190 adult coronary and valve pati ents who underwent surgery at our hospital during the 5-year period fr om 1987 to 1991. During this period 889 (40.6%) patients were given '' high dose'' aprotinin. Their mean age was 59.3+/-8.8 years, 1636 (74.7 %) were males, 200 (9.1%) underwent surgery on an emergency basis and 72 patients (3.3%) underwent redo-operations. The patients were divide d into four groups according to the type of surgery: all patients pool ed together (2190), coronary artery surgery patients (1384, 63.2%, gro up I), valve surgery patients (706, 32.2%, group II) and combined (cor onary plus valve) surgery patients (100, 4.6%, group III). Stepwise lo gistic regression analysis, performed to assess the risk factors for r evisions due to bleeding showed aprotinin treatment to be the sole pro tective factor in all patients, group I and group II. In group III onl y the use of a hollow fiber membrane oxygenator proved a protective fa ctor. Risk factors for revisions for bleeding were found to be aortic cross-clamp time in all patients, group I and group II. Use of the int ernal thoracic artery (ITA) was significant in group I patients and ag e at operation in group II. Multiple stepwise linear regression analys is, performed to evaluate the effect of various risk factors on cumula tive postoperative blood loss in all patients, confirmed aprotinin as the only factor capable of reducing blood loss, while aortic cross-cla mp time, coronary surgery and male gender showed a positive linear rel ation with postoperative bleeding. When multiple stepwise linear regre ssion analysis was performed on group I patients, aprotinin and the ho llow fiber oxygenator emerged as protective factors, while aortic cros s-clamp time, male gender and use of ITA were risk factors for postope rative bleeding. ''High dose'' aprotinin administration is an importan t tool in reducing blood loss and in avoiding revisions for bleeding i n adult cardiac surgery.