RETRACTED: Aprotinin in pediatric cardiac operations: Platelet function, blood loss, and use of homologous blood

Boldt, Joachim; Knothe, Christoph; Zickmann, B.; Wege, Niels; Dapper, F.; Hempelmann, G.

doi:10.1016/0003-4975(93)91088-5

Cited by 50 publications

(20 citation statements)

References 32 publications

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“…The mean blood loss values for G1 and G2 were 28.6 ± 36.7 and 15.0 ± 21.2 mL/kg, respectively. Higher blood loss in infants weighing less than 10 kg has also been reported in open heart surgery [20] . Indeed, blood loss and transfusion requirements were correlated inversely with age and body weight [20] .…”

Section: Discussionmentioning

confidence: 65%

“…Higher blood loss in infants weighing less than 10 kg has also been reported in open heart surgery [20] . Indeed, blood loss and transfusion requirements were correlated inversely with age and body weight [20] . More blood loss may cause more labile hemodynamic changes, the development of metabolic acidosis and higher incidences of ionized hypocalcemia [12] .…”

Section: Discussionmentioning

confidence: 65%

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Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

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AIM:To compare the outcomes of pediatric patients weighing less than or more than 10 kg who underwent liver transplantation. METHODS: Data for 196 pediatric patients who underwent living donor liver transplantation betweenJune 1994 and February 2011 were reviewed retrospectively. The information for each patient was anonymized and de-identified before analysis. The data included information regarding the pre-transplant conditions, intraoperative fluid replacement and outcomes for each patient. The 196 patients were divided into two groups: those with body weights of less than 10 kg were included in group 1 (G1; n = 101), while those with body weights of more than 10 kg were included in group 2 (G2; n = 95). For each group, the patients' ages, body weights, heights, pediatric end stage liver disease scores, anesthesia times, and warm and cold ischemic times were analyzed. In addition, between-group comparisons were also made. Mann-Whitney U tests were used to compare all the variables except for complications and survival rates, which were analyzed using χ 2 tests and Kaplan-Meier tests, respectively. RESULTS:The general medical conditions of the G1 Retrospective StudyLiving donor liver transplantation with body-weight more or less than 10 kilograms patients were worse than those of the G2 patients, as shown by the higher pediatric end stage liver disease scores and poorer Z -scores. In addition, the preoperative Hb and serum albumin levels were all lower for the G1 patients than for the G2 patients. The G1 patients also had significantly more intraoperative blood loss than the G2 patients. In addition, the intraoperative fluid requirements for the G1 patients, including leukocyte poor red blood cell transfusions, 5% albumin infusions and crystalloid infusions, were significantly higher than those for the G2 patients. The risk of intraoperative portal vein thrombosis was higher for the patients in G1 than for those in G2. However, the one-year survival rates (95.9% and 96.8% for G1 and G2, respectively) and three-year survival rates (94.9% and 94.6% for G1 and G2, respectively) for both groups were similar. CONCLUSION:Patients weighing less than 10 kg typically have poorer conditions, but their survival rates are comparable to those of children weighing more than 10 kg. Core tip: Although pediatric patients weighing less than 10 kg who underwent living donor liver transplantation usually had worse pre-transplant conditions, more intraoperative bleeding and more portal vein complications, their three-year survival rate was 94%, a rate comparable to that achieved by children weighing more than 10 kg. A prerequisite for achieving these excellent results is good and effective teamwork. Cooperation between surgeons, plastic surgeons, and anesthesiologists in the operating theater is fundamental, but the contributions of radiologists are also critical. Radiologists should be available in the operating room to perform Doppler ultrasounds or place vascular stents, as required.Yang SC, Huang CJ, Chen CL, Wang CH,...

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 65%

Living donor liver transplantation with body-weight more or less than 10 kilograms

Yang

Huang

Chen

et al. 2015

WJG

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“…One of the benefi ts of aprotinin is its ability to preserve platelet function, even in patients treated with aspirin preoperatively. The favorable effects on platelets can be achieved with either the low-dose or high-dose protocol [77][78][79]. This effect on platelets has been hypothesized to be from inhibition of plasmin by aprotinin [80].…”

Section: Antifibrinolytic Agentsmentioning

confidence: 99%

Cardiopulmonary Bypass

McLean¹,

Lombardi²,

Pearl³

2008

Cardiovascular Pediatric Critical Illness and Injury

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“…In pediatrics, there are no universal dosage guidelines for cardiac surgical patients, and many dosing regimens have been tried successfully in this particular patient population. [84][85][86][87][88] Our dosing regimen is 30,000 KIU/kg load, 30,000 KIU/kg in the pump prime, and 30,000 KIU/kg/hr up to 50 mL/hr maximum drip rate. There are concerns in the adult literature about stroke, renal dysfunction, graft patency and anaphylaxis.…”

Section: Aprotinin (Trasylol)mentioning

confidence: 99%

Blood Conservation During Pediatric Cardiac Surgery

Gómez

Olshove

Weinstein

et al. 2002

Transfus Alt Transfus Med

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1 Blood conservation techniques in adult and pediatric cardiac surgery have evolved over the past 50 years. Congenital cardiac surgical repair with CPB has induced up to a 300% hemodilutional effect.2,3 In the 1960s, disposable CPB equipment was developed and non-heme primes were utilized to reduce transfusion exposure. 4,5Today, the first question many parents ask is not "Is my child fine?" but "Did my child receive any blood?" The public's perception of banked blood being tainted has prompted surgeons to limit or eliminate blood transfusions. Autologous donation has helped reduce the need for homologous transfusion. In pediatrics, however, this technique is limited by kilogram weight.6 Indeed, weight loss and preoperative anemia have been found to be highly significant predictors for the need of red blood cell transfusion and postoperative morbidity. 7-12Cardiopulmonary bypass causes a total body inflammatory response and dilution of coagulation factors, a phenomenon which exacerbates postoperative bleeding. Preoperative treatment of anemia and coagulation imbalances has reduced blood transfusions. 13 The use of antifibrinolytics has changed transfusion patterns due to reduced postoperative bleeding. Cell salvaging systems have become commonplace in the operating room and intensive care unit. Modified ultrafiltration, commonly used in pediatrics, has been effective in increasing hematocrit (Hct) levels, concentrating patient plasma volume, and reducing the body's inflammatory response to cardiopulmonary bypass.

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RETRACTED: Aprotinin in pediatric cardiac operations: Platelet function, blood loss, and use of homologous blood

Cited by 50 publications

References 32 publications

Living donor liver transplantation with body-weight more or less than 10 kilograms

Living donor liver transplantation with body-weight more or less than 10 kilograms

Cardiopulmonary Bypass

Blood Conservation During Pediatric Cardiac Surgery

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