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Purpose: Atrial fibrillation remains the leading postoperative complication following cardiopulmonary bypass. A randomized trial was undertaken to evaluate the effectiveness of leukocyte filtration and aprotinin, applied separately and in combination, on the incidence of post-operative atrial fibrillation. A secondary component of the study was the impact of these adjunct interventions on post-surgical renal and neurological dysfunction.Methods: A total of 1,220 patients undergoing primary isolated coronary artery bypass grafting were randomly assigned to one of four treatment groups. The control group (305 patients) received standard cardiopulmonary bypass with moderately hypothermic (34ºC) cardioplegic arrest. In the filtration group (310 patients) leukocyte reducing filters were incorporated into the bypass circuit and deployed strategically. The aprotinin group (285 patients) received full Hammersmith dose aprotinin. The combination therapy group (320 patients) received both aprotinin and leukocyte filtration. Results:The incidences of atrial fibrillation were 25% in the control group, 16% in the filtration group, 19% in the aprotinin group and 10% in the combination therapy group (P < 0.001). Renal dysfunction was detected in 3% of the control group, 2% of the filtration group, 8% of the aprotinin group, and 5% of the combination group (P < 0.005). Neurological dysfunction occurred in 2% of the control group, 2% of the filtration group, 1% of the aprotinin group, and 2% of the combination group (P = n.s.).Conclusions:Combination therapy with aprotinin and leukocyte filtration markedly reduced atrial fibrillation post-cardiopulmonary bypass, and was more effective than the individual treatments. Aprotinin treatment increased the incidence of renal dysfunction, and the addition of leukocyte filtration partially mitigated this detrimental effect of aprotinin. Thus, strategic leukocyte filtration augments aprotinin's anti-arrhythmic effects while suppressing its nephrotoxic sequelae.

<p>Like-minded structural engineering organizations should work together to allow participants in the design and construction industry to more readily operate on a global platform. We call this Global Interoperability, and in its most general sense it is a vision where our industry is structured to readily facilitate people, organizations, and systems to work across geographic and other boundaries.</p><p>Besides the obvious benefit of sharing of resources to achieve a common goal, Global Interoperability will be particularly advantageous for structural engineers who are highly qualified, globally adept, creative, and value-producing.</p><p>The idea of Global Interoperability does not imply a homogenization of education, licensure, standards, and language. Indeed, regional differences in approach are both expected and desirable to foster innovation. Instead, the goal of Global Interoperability should be to identify and break down unnecessary and wasteful barriers to collaboration and enable the advancement of the profession worldwide. Some elements of standards and practices may be common across boundaries. In other cases, say in codes and standards, it may be desirable to define a structure or framework for a global approach, which accommodates regional variations.</p><p>Global Interoperability is a long-term vision and results of deliberate collaboration with other professionals in the field of structural engineering, and will require a sustained, incremental progress to promote a successful structural engineering profession. Other industries such as medicine, law, and public safety are working towards Global Interoperability. To the author’s knowledge no structural engineering organization has taken a leadership role in promoting Global Interoperability.</p>

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