Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Mangano, Christina Mora; Neville, Michael J.; Hsu, Ping H.; Mignea, Iulia; King, Jennifer R.; Miller, D. Craig

doi:10.1161/hc37t1.094702

Cited by 77 publications

(52 citation statements)

References 26 publications

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“…In a study of 853 patients after complex aortic surgery including periods of hypothermic circulatory arrest, aprotinin use was not associated with renal dysfunction or failure. 23 In another large meta-analysis of prospective randomized trials of aprotinin recently published by Sedrakyan et al, 18 there was no increase in renal dysfunction/failure in aprotinin-treated patients.…”

Section: Article P 2801mentioning

confidence: 95%

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Bridges

2007

Circulation

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Section: Article P 2801mentioning

confidence: 95%

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Bridges

2007

Circulation

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“…For these reasons, there has been concern that the use of aprotinin may lead to renal injury. Several studies in patients who underwent CPB, as well as liver transplantation, did not demonstrate any renal toxicity directly attributable to aprotinin use (113)(114)(115).…”

Section: Other Events Associated With Cpbmentioning

confidence: 99%

Acute Kidney Injury Associated with Cardiac Surgery

Rosner

Okusa²

2006

Clinical Journal of the American Society of Nephrology

907

681

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Acute renal failure (ARF) occurs in up to 30% of patients who undergo cardiac surgery, with dialysis being required in approximately 1% of all patients. The development of ARF is associated with substantial morbidity and mortality independent of all other factors. The pathogenesis of ARF involves multiple pathways. Hemodynamic, inflammatory, and nephrotoxic factors are involved and overlap each other in leading to kidney injury. Clinical studies have identified risk factors for ARF that can be used to determine effectively the risk for ARF in patients who undergo bypass surgery. These high-risk patients then can be targeted for renal protective strategies. Thus far, no single strategy has demonstrated conclusively its ability to prevent renal injury after bypass surgery. Several compounds such as atrial natriuretic peptide and N-acetylcysteine have shown promise, but large-scale trials are needed.Clin -15). ARF that requires dialysis occurs in approximately 1% (1-15). The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications (1-15). Even minimal changes in serum creatinine that occur in the postoperative period are associated with a substantial decrease in survival (16). Furthermore, the majority of patients who develop ARF that requires dialysis (ARF-D) remain dialysis dependent, leading to significant long-term morbidity and mortality (17). Despite advances in bypass techniques, intensive care, and delivery of hemodialysis, mortality and morbidity associated with ARF have not markedly changed in the last decade (1-15). These data highlight the importance of understanding the pathophysiology of ARF associated with cardiac bypass surgery and implementing specific therapies that are based on this knowledge in well-designed clinical trials. Incidence and Prognosis of ARF after Bypass SurgeryDepending on the definition of ARF, the incidence of ARF varies across studies, with a range of 1 to 30% (1-15). Conlon et al.(1) described a cohort of 2843 patients who underwent cardiopulmonary bypass (CPB) over a 2-yr period. ARF (defined as a rise in serum creatinine Ͼ1 mg/dl above baseline) occurred in 7.9% of patients, and ARF-D occurred in 0.7%. Other studies that used a definition of ARF as a 50% or greater rise in serum creatinine from baseline demonstrated a rate as high as 30% (2-15). Chertow et al. (15) analyzed 42,773 patients who underwent CPB and found an incidence of ARF-D of 1.1%. The incidence of ARF is dependent on the particular type of CPB surgery. Typical coronary artery bypass grafting has the lowest incidence of ARF (approximately 2.5%) and ARF-D (approximately 1%), followed by valvular surgery with an incidence of ARF of 2.8% and ARF-D of 1.7% (18,19). The highest risk group includes combined coronary artery bypass grafting/valvular surgery with an incidence of ARF of 4.6% and ARF-D of 3.3% (18,19) Mortality associated with the development of ARF is as high as 60% in some studies but likely averages 15 to 3...

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“…29,31 Consistent with this, we found a linear relationship between CPB duration and risk of MBT (Figure 1). Deep hypothermic circulatory arrest, which not only prolongs CPB duration but also has detrimental effects on platelet function that are additive to those of CPB, 32 was also an important predictor of MBT. Another important predictor was pre-existing thrombocytopenia, with the risk most pronounced when platelet counts were less than 100 x 10 9 ·L -1 .…”

Section: Independent Predictors Of Mbt As Identified By the Predictiomentioning

confidence: 99%

Prediction of massive blood transfusion in cardiac surgery

Karkouti

O’Farrell

Yau

et al. 2006

Can J Anesth/J Can Anesth

116

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Purpose:In cardiac surgery with cardiopulmonary bypass (CPB), excessive blood loss requiring the transfusion of multiple red blood cell (RBC) units is a common complication that is associated with significant morbidity and mortality. The objective of this study was to develop a prediction rule for massive blood transfusion (MBT) that could be used to optimize the management of, and research on, at-risk patients.Methods: Data were collected prospectively over the period from 2000 to 2005, on patients who underwent surgery with CPB at one hospital. Patients who received ≥ five units of RBC within one day of surgery were classified as MBT. Logistic regression was used to appropriately select and weigh perioperative variables in the prediction rule, which was developed on the initial 60% of the sample and validated on the remaining 40%.Results: Of the 10,667 patients included, 925 (8.7%) had MBT. The clinical prediction rule included 12 variables (listed in order of predictive value: CPB duration, preoperative hemoglobin concentration, body surface area, nadir CPB hematocrit, previous sternotomy, preoperative shock, preoperative platelet count, urgency of surgery, age, surgeon, deep hypothermic circulatory arrest, and type of procedure) and was highly discriminative (c-index = 0.88). In the validation set, those classified as low-, moderate-, and high-risk by a simple risk score derived from the prediction rule had a 5%, 27%, and 58% chance of MBT, respectively. Conclusion:A clinical prediction rule was developed that accurately identified patients at low-risk or high-risk for MBT. Studies are needed to determine the external generalizability and clinical utility of the prediction rule. Objectif : En cardiochirurgie avec circulation extracorporelle (CEC), une perte de sang excessive exigeant la transfusion de multiples unités de culots globulaires (CG) est une complication

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Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest

Cited by 77 publications

References 26 publications

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Valid Comparisons of Antifibrinolytic Agents Used in Cardiac Surgery

Acute Kidney Injury Associated with Cardiac Surgery

Prediction of massive blood transfusion in cardiac surgery

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