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J Thorac Cardiovasc Surg 1995;110:1615-1622
© 1995 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
New York, N.Y.
From the Department of Surgery, Division of Cardiac Surgery, College of Physicians and Surgeons, Columbia University, New York.
Received for publication Jan. 6, 1995. Accepted for publication May 9, 1995. Address for reprints: Craig R. Smith, MD, Columbia Presbyterian Medical Center, 630 W. 168th St., Milstein Building, 7th floor, 7GN-435, New York, NY 10032.
Abstract
Aprotinin has been successfully used to reduce blood loss and blood product requirements in patients undergoing primary and reoperative cardiac operations. Its safety and efficacy during profound hypothermia and circulatory arrest have been questioned, however. A retrospective review compared 24 patients who received aprotinin during complex aortic procedures under profound hypothermia and circulatory arrest with 24 age-matched patients undergoing similar procedures without aprotinin. Activated clotting time was maintained at longer than 500 seconds (kaolin activating agent) or longer than 750 seconds (celite). We observed no statistically significant difference in the incidence of neurologic events (p not significant) or myocardial infarctions (p not significant), and there was a trend toward reduced in-hospital mortality rate in aprotinin-treated patients. A higher incidence of postoperative renal dysfunction was encountered in aprotinin-treated patients. Aprotinin recipients had a significant reduction in requirements for postoperative homologous erythrocytes (p = 0.01). We conclude that aprotinin may be safely and effectively used in patients undergoing deep hypothermia and circulatory arrest. (J THORAC CARDIOVASC SURG 1995;110:1615-22)
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