THE EFFICACY AND COST OF APROTININ IN CHILDREN UNDERGOING REOPERATIVEOPEN-HEART-SURGERY

We performed a prospective, randomized, placebo-controlled, double-bli nd trial to assess the efficacy of aprotinin in 61 children (median ag e 3.7 yr) undergoing reoperative open heart surgery (OHS). Three demog raphically similar groups were studied: large-dose aprotinin (ALD), sm all-dose aprotinin (ASD), and placebo (P). Over the first 24 postopera tive hours fewer patients in the aprotinin groups received packed red cells (ALD, 53%; ASD, 89%; and P, 95%; P = 0.001), platelets (ALD, 32% ; ASD, 50%; and P, 65%; P = 0.04), and fresh frozen plasma (ALD, 16%; ASD, 17%; and P, 60%; P = 0.003) than placebo patients. Most important ly, aprotinin patients had fewer exposures to banked blood components (ALD, median 1 U; and ASD, median 2 U) than P (median 6 U; P = 0.001), with no difference in overall complication rate. Use of aprotinin was associated with a savings in the patient charges for blood components , operating room time, and duration of hospitalization. In conclusion, aprotinin decreased the number of units of banked blood components us ed during the first 24 postoperative hours in reoperative pediatric OH S. Aprotinin thus decreases the risks associated with exposure to bank ed blood components and reduces hospital charges.