Desmopressin does not reduce bleeding and transfusion requirements in congenital heart operations

Background. Desmopressin (DDAVP) has been evaluated in many randomized clin ical trials as a means to reduce blood loss and transfusion of allogeneic b lood in cardiac operation requiring cardiopulmonary bypass. Desmopressin re duces blood loss in adult patients with excessive bleeding after cardiac op eration. Its usefulness in patients undergoing complex congenital heart rep air with cardiopulmonary bypass is unproved. Methods. Sixty patients younger than 40 years of age scheduled for complex congenital heart operation (44 redo, 16 primary) were enrolled in this pros pective, randomized, double-blind trial. Desmopressin 0.3 mug/kg or placebo was administered 10 minutes after protamine administration. Transfusion re quirements and postoperative blood loss were recorded. Differences were ana lyzed using analysis of variance with a p value of 0.05 or less used to den ote statistical significance. Results. There were no differences in demographic or surgical characteristi cs between the DDAVP or placebo groups. There was no difference in blood lo ss and transfusion requirements between the DDAVP and placebo groups. Durin g the intraoperative postinfusion time period, the median blood loss for re do patients was 343 versus 357 mL/m(2) for placebo versus DDAVP, respective ly, and for primary patients, the median blood loss was 277 versus 228 mL/m 2. Conclusions. The prophylactic use of DDAVP to reduce excessive bleeding or transfusion requirements in patients undergoing complex congenital heart op erations is not warranted. (Ann Thorac Surg 2000;70:1923-30) (C) 2000 by Th e Society of Thoracic Surgeons.