The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 6 , Pages 1421-1428, December 2007

Aprotinin is safe in pediatric patients undergoing cardiac surgery

Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-9, 2007.

  • Carl L. Backer, MD

      Affiliations

    • Division of Cardiovascular–Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • Corresponding Author InformationAddress for reprints: Carl L. Backer, MD, Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, 2300 Children’s Plaza, mc 22, Chicago, IL 60614.
    • ,
  • Angela M. Kelle, BS

      Affiliations

    • Division of Cardiovascular–Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Robert D. Stewart, MD, MPH

      Affiliations

    • Division of Cardiovascular–Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Sunitha C. Suresh

      Affiliations

    • Division of Cardiovascular–Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Farah N. Ali, MD

      Affiliations

    • Division of Kidney Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Richard A. Cohn, MD

      Affiliations

    • Division of Kidney Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Roopa Seshadri, PhD

      Affiliations

    • Children’s Memorial Hospital, and the Department of Pediatrics and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. and Mary Ann and J. Milburn Smith Child Health Research Program, Children’s Memorial Research Center, Chicago, Ill.
    • ,
  • Constantine Mavroudis, MD

      Affiliations

    • Division of Cardiovascular–Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill

Received 16 May 2007; received in revised form 19 July 2007; accepted 7 August 2007. published online 22 October 2007.

Objective

Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass.

Methods

We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994–1999, when aprotinin was not used (n = 1230), with a cohort from 2000–2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate.

Results

The aprotinin group was younger (mean age, 3.49 ± 1.84 vs 3.64 ± 4.75 years; P = .019) and had a higher Aristotle score (7.8 ± 2.3 vs 7.2 ± 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5%] vs 47 [3.8%], P = .508), acute kidney failure (68 [6.0%] vs 69 [5.7%], P = .77), need for temporary dialysis (6 [0.49%] vs 12 [0.96%], P = .17), or neurologic complications (14 [1.1%] vs 17 [1.4%], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078).

Conclusion

In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.

CTSNet classification: 16, 21, 27

Abbreviations and Acronyms: CPB, cardiopulmonary bypass, DHCA, deep hypothermic circulatory arrest

 

PII: S0022-5223(07)01362-1

doi:10.1016/j.jtcvs.2007.08.006

The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 6 , Pages 1421-1428, December 2007

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