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[Use of aprotinin during pediatric heart surgery]
S Martín Burcio1, J Valiño González, F Domínguez
1Servicio de Anestesiología y Reanimación. Hospital Ramón y Cajal. Madrid.
Insights
High-dose aprotinin effectively reduced blood loss and transfusion needs in pediatric cardiac surgery patients. This study found no complications associated with aprotinin use in these high-risk children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Pharmacology
Background:
- Pediatric patients undergoing cardiopulmonary bypass (CPBP), especially those with cyanotic heart disease or reoperations, face a high risk of bleeding.
- Managing intra- and postoperative hemorrhage is critical in this population to minimize complications and improve outcomes.
Purpose of the Study:
- To evaluate the efficacy of high-dose aprotinin in reducing blood loss and transfusion requirements during CPBP in pediatric patients.
- To assess the safety of high-dose aprotinin in children with a propensity for bleeding, including those with cyanotic heart disease and those undergoing repeat surgeries.
Main Methods:
- A retrospective study of 71 pediatric patients with cyanotic heart disease undergoing CPBP.
- Group I received a specific high-dose aprotinin regimen, while Group II served as a control.
- Key metrics included red blood cell loss, blood product requirements, diuresis, and complications within the first 24 hours post-ICU admission.
Main Results:
- Patients receiving high-dose aprotinin (Group I) showed significantly lower packed red blood cell requirements (13.96 ml/kg/h vs. 22 ml/kg/h) compared to the control group (Group II).
- Aprotinin administration also resulted in significantly less blood volume loss (0.77 ml/kg/h vs. 2.12 ml/kg/h).
- Intra- and postoperative diuresis in the first 24 hours did not differ significantly between the groups.
Conclusions:
- High-dose aprotinin significantly reduces red blood cell loss and the need for homologous blood transfusions in pediatric patients undergoing CPBP.
- No adverse events or complications were attributed to the use of aprotinin in this study cohort.
- Aprotinin is a safe and effectiveadjunct for managing bleeding risks in high-risk pediatric cardiac surgery patients.
Objective:
To study the efficacy of high doses of aprotinin during cardiopulmonary bypass (CPBP) in pediatric patients with a tendency to intra- and postoperative bleeding: children undergoing repeated operations and those with cyanotic cardiopathy.
Patients And Methods:
A simple retrospective, random sample of 71 pediatric patients with cyanogenic cardiopathy was studied. Group I (n = 36) received a test dose of 50,000 KIU in 2 min. The initial dose was 1,700,000 KIU (170 ml/m2 of body surface) i.v., at an infusion rate of 150 ml/h. CPBP circuit prime dose was 1,700,000 (170 ml/m2 of body surface), with replacement at a volume equivalent to the circuit prime. The maintenance dose was 400,000 KIU (40 ml/m2/h) i.v. Infusion was suspended 2 hours after a patient's arrival at the intensive care unit (ICU). We recorded red blood cell loss and blood product requirements in the first 24 hours in the ICU, duration of surgery, intra- and postoperative diuresis, and complications.
Results:
Group I required 13.96 +/- 12.09 ml/kg/h of packed red cells whereas Group II required 22 +/- 16.22 ml/kg/h (p < 0.05). The volume lost was less in Group I than in Group II (0.77 +/- 0.48 ml/kg/h vs. 2.12 +/- 3.9 ml/kg/h; p < 0.05). The means for intra- and postoperative diuresis in the first 24 hours were not significantly different.
Conclusions:
Aprotinin significantly reduces red blood cell loss and homologous blood transfusion requirements. No complications attributable to aprotinin were observed.