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J Thorac Cardiovasc Surg 2003;125:184-190
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Does aprotinin influence the inflammatory response to cardiopulmonary bypass in patients?

From the Departments of Anesthesiology,^a Intensive Care Medicine,^b and Anesthesiology,^c Erasme University Hospital, and the Department of Immunology,^d Brugmann University Hospital, Brussels, Belgium.

This work was supported by a grant from Bayer, Leverkusen, Germany.

Presented in part at the Annual Meeting of the American Society of Anesthesiologists, Orlando, Fla, October 1998.

Received for publication April 16, 2001. Revisions requested June 26, 2001; revisions received July 25, 2001. Accepted for publication Nov 15, 2001. Address for reprints: Denis Schmartz, MD, Department of Anesthesiology, Erasme University Hospital, 808 route de Lennik, B-1070 Brussels, Belgium (E-mail: denis.schmartz{at}ulb.ac.be).

Objectives: Aprotinin has been shown to have anti-inflammatory properties, but its effects on the inflammatory reaction to cardiopulmonary bypass remain controversial. This prospective, randomized, double-blind study evaluated the influence of aprotinin on various blood markers of inflammation during and after cardiopulmonary bypass.
Methods: Sixty male patients underwent coronary artery bypass grafting. The patients were randomized into 3 groups: a placebo group, a second group receiving 2,000,000 KIU of aprotinin followed by an infusion of 500,000 KIU/h and 2,000,000 KIU in the pump prime, and a third group receiving half this dosage. Measurements of tumor necrosis factor, interleukin 6, interleukin 8, interleukin 10, endotoxin, histamine, complement factors, prekallikrein, and prostaglandin D₂ were obtained at baseline, 30 minutes after study drug loading, 10 minutes after the beginning of cardiopulmonary bypass, before the end of bypass, 4 hours after bypass, and on the first and second postoperative days.
Results: Aprotinin had no significant effect on any of these parameters. As expected, aprotinin reduced early blood loss in both treated groups.
Conclusions: These results indicate that aprotinin at doses currently used to reduce blood loss has no significant influence on the systemic inflammatory response during moderate hypothermic cardiopulmonary bypass in human subjects, as assessed by the mediators measured in this study.

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