Aprotinin in deep hypothermic circulatory arrest

Early experience with aprotinin in deep hypothermic circulatory arrest (DHC A) raised alarm about hazards associated with its use. Based on what little is known about possible mechanistic interactions between hypothermia, stas is, and aprotinin, there is no evidence that aprotinin becomes unusually ha zardous in DHCA. Excessive mortality and complication rates have only been reported in clinical series in which the adequacy of heparinization is ques tionable. Benefits associated with use of aprotinin in DHCA have been incon sistently demonstrated. The only prospective, randomized series showed sign ificant reduction in blood loss and transfusion requirements. Use of aproti nin in DHCA should be based on the same considerations applied in other car diothoracic procedures. (C) 1999 by The Society of Thoracic Surgeons.