The Use of Aprotinin in Pediatric Cardiac Surgery

Abstract

SUMMARY The use of aprotinin in children undergoing cardiopulmonary bypass (CPB) attenuates activation of the coagulation and fibrinolytic systems, preserves platelet function, and reduces some inflammatory processes. The clinical outcomes in children as a result of these effects have varied among studies and patient populations, however, this is probably in large part due to variations in dosing regimens. Nevertheless, improved clinical outcomes have been consistently demonstrated in neonates undergoing primary sternotomies and in children undergoing repeat sternotomies or lung transplantation with the use of aprotinin. Such clinical outcomes create a strong argument for the routine administration of aprotinin to these subsets of children. The magnitude of beneficial clinical outcomes after aprotinin administration is dose‐dependent so, while a definitive dosing regimen has not been established for children, higher dose regimens should be employed. Indeed, the use of some very high dose regimens have indicated that aprotinin may even be beneficial in children, other than neonates, undergoing primary sternotomies. The occurrence of adverse effects from the use of aprotinin in children is low but allergic reactions from repeat exposures, especially within six months of the prior use of aprotinin, must be anticipated and guidelines followed to minimize their occurrence and effects. Aprotinin is a potent part of a clinician's arsenal when dealing with children undergoing CPB and its cost‐effective improvement of clinical outcomes justifies its consideration when planning the management strategy of these children.