APROTININ IN AORTIC-SURGERY REQUIRING PROFOUND HYPOTHERMIA AND CIRCULATORY ARREST

Objective: The use of aprotinin in cardiac surgery to improve haemosta sis and reduce blood loss particularly in patient groups at increased risk of bleeding is well established. Previous retrospective studies i n profound hypothermic surgery have highlighted concerns that in this circumstance aprotinin may paradoxically cause increased bleeding and intravascular thrombosis. We therefore adopted a modified protocol for administering aprotinin, which was not started until cardiopulmonary bypass had been reinstituted after circulatory arrest. Methods: Betwee n April 1993 and June 1995, 45 patients underwent 46 thoracic aortic p rocedures which required hypothermic circulatory arrest; 25 of these w ere emergencies. All of these patients received aprotinin. Results: Th ere were five deaths (10.8%) in hospital. Two patients with preoperati ve oliguric renal failure required postoperative dialysis, and a furth er six (13%) developed transient renal dysfunction with complete recov ery. Two patients suffered postoperative stroke; one from embolisation of a severely diseased aorta, while the other had signs of an acute e volving stroke before surgery. None of the patients suffered acute Q-w ave perioperative myocardial infarction. The mean blood loss was 575 m l in the first 12 h, with a mean postoperative transfusion requirement of 1 U blood. Conclusions: We cannot implicate aprotinin in increased postoperative blood loss, renal dysfunction or mortality when used wi th hypothermic circulatory arrest according to this protocol. Elucidat ing the role of aprotinin in hypothermic circulatory arrest requires a randomised prospective study. (C) 1997 Elsevier Science B.V.