The effect of controlled aprotinin administration through cardiotomy suction during cardiopulmonary bypass

Cardiotomy suction enhances inflammation and fibrinolysis during cardiopulmonary bypass (CPB). Aprotinin has been shown to reduce the generalized inflammatory insults associated with CPB. The purpose of this study was to evaluate the effect of Aprotinin administration through cardiotomy suction on the inflammatory and fibrinolytic responses during CPB. A pig model of CPB was utilized including 8 animals divided into control and treatment groups. In the treatment group, Aprotinin was infused into the cardiotomy suction (3000 KIU/min), while the same volume of saline was infused in the control group. D-dimer, platelet count, and IL-8 level were analyzed from systemic and cardiotomy suction. It was found that Aprotinin significantly suppressed the increase in D-dimer levels in the systemic (476.3 +/- 341.2 vs. 1218.8 +/- 281.3 ng/ml, p < 0.05) and the cardiotomy suction (565.0 +/- 192.5 vs. 1875.0 +/- 125.0 ng/ml, p < 0.05). Platelet count fell in both groups during CPB, although the reduction was greater in the control (13.1 +/- 5.1 vs. 37.9 +/- 13.8%, p < 0.05). In addition, IL-8 level in the suction solution was significantly lower in the Aprotinin group (56.5 +/- 18.0 vs. 136.3 +/- 14.8 pg/ml, p < 0.05). In conclusion, this study suggested that Aprotinin treatment of the cardiotomy solution might be an effective way of reducing fibrinolysis, platelet reduction, and inflammation associated with CPB.