Aprotinin in open-heart surgery of infants and children using the heart-lung machine

The purpose of this study was to evaluate a new approach to managing thrombohemorrhagic diathesis in infants and children undergoing extracorporeal circulation during open-heart surgery. Treatment consisted of administering vitamin K1 and aprotinin preoperatively as well as during bypass and after neutralization of heparin. Operative techniques were either surface-induced deep hypothermia and total circulating arrest or conventional bypass with mild-to-moderate hypothermia. At completion of the intracardiac repair, heparin was neutralized with protamine chloride (1:0.7-0.8). Complete bleeding and clotting studies were carried out in 122 patients before, during, and after the bypass procedure. Most of the infants, especially those with congenital cyanotic heart disease, had marked fibrinolysis and vitamin K1 deficiency preoperatively. All patients postoperatively exhibited fibrinolysis and proteolysis greatly exceeding normal values with increased bleeding tendency. The treatment significantly reduced blood loss and transfusion requirements.