Role of aprotinin in the management of patients during and after cardiac surgery

Abstract

Management of patients undergoing cardiac surgery has evolved in recent years as more is understood about the physiological changes and responses that occur during and after cardiopulmonary bypass (CPB). In particular, our understanding of the mechanisms involved in haemostasis and in the inflammatory response to bypass surgery, has allowed significant refinements in patient management. Improvements in the pharmacological conservation of blood loss have been striking, particularly with the development of the serine protease inhibitor, aprotinin (Trasylol, Bayer). Aprotinin represents a significant improvement, especially for patients at high risk, since it reduces the need for allogeneic and (sometimes scarce) blood products. However, in view of its cost, making an appropriate selection of patients most at risk of serious blood loss is a major consideration in the use of aprotinin. While its mechanisms of action are not well understood, the use of aprotinin also appears to reduce inflammatory response to CPB.

Potential for benefits of aprotinin use to outweigh risks in patients undergoing the Ross procedure

“…Idiopathic pulmonary artery aneurysms are rare, 4,5 with an estimated incidence of 1 in 13,696 in an autopsy series. 5 Similar to ascending aortic aneurysm, idiopathic pulmonary aneurysm may be associated with the presence of congenital bicuspid pulmonary valves, 6 a rare entity 7 in the absence of congenital heart disease. However, in contrast with our case, the study by Sughimoto and colleagues 6 did not find medial necrosis.…”

“…5 Aprotinin was administered routinely to all patients, according to the full Hammersmith protocol. 6 Mean age was 39.5 years (range 15-62 years). Mean total bypass time was 195 minutes, and mean cumulative crossclamp time was 165 minutes.…”

Leucocyte depletion in cardiopulmonary bypass: a comparison of four strategies

“…Pharmacological strategy, for example aprotinin, is an effective therapeutic method for preventing or at least modifying the adverse phenomenon of SIR, but it does not eliminate the basic causative factor. 17 A biocompatible bypass circuit, for instance, heparincoated extracorporeal circuits, is another strategy that has been employed to attenuate the inflammatory reaction. 18 ] 20 The leucocyte filter that preferentially removes only activated neutrophils is a new, and apparently successful, addition to the antiinflammatory arsenal.…”