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[Effects of "low dose" aprotinin in open heart surgery and its plasma concentration]
T Nakamura1, M Shimamoto, F Yamazaki
1Department of Cardiovascular Surgery, Shizuoka City Hospital, Japan.
Insights
Low-dose aprotinin significantly reduced bleeding and homologous blood transfusions in open heart surgery patients. This antifibrinolytic agent also shortened cardiopulmonary bypass and operation times, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Open heart surgery, including CABG and valve replacement, carries risks of significant blood loss.
- Aprotinin is an antifibrinolytic agent used to reduce bleeding during surgical procedures.
Purpose of the Study:
- To evaluate the efficacy of low-dose aprotinin in minimizing blood loss and transfusion requirements during open heart surgery.
- To assess the impact of low-dose aprotinin on cardiopulmonary bypass and overall operation times.
Main Methods:
- A prospective study involving 109 patients undergoing CABG or prosthetic valve replacement.
- Group A received a specific low-dose aprotinin regimen, while Group C served as the control without aprotinin or placebo.
- Continuous infusion and prime volume administration of aprotinin were employed in Group A.
Main Results:
- Significantly reduced postoperative bleeding (after ECC, 6-hour, and 24-hour drainage) in the aprotinin group compared to the control.
- Markedly lower homologous blood transfusion requirements in patients receiving aprotinin.
- Shorter cardiopulmonary bypass (ECC) and operation times observed in the aprotinin group.
Conclusions:
- Low-dose aprotinin is effective in reducing perioperative blood loss and the need for allogeneic blood transfusions in open heart surgery.
- The use of aprotinin in this regimen also led to a significant reduction in cardiopulmonary bypass and operative durations.
- Aprotinin administration demonstrated a positive impact on patient outcomes by minimizing transfusion-associated risks and surgical time.
Abstract:
To determine the effects of "low dose" aprotinin in open heart surgery, we administrated it in 109 cases of CABG or prosthetic valve replacement. Patients in Group A (Aprotinin) received continuous infusion of aprotinin at the rate of 6*10(5) KIU/hr from the induction of anesthesia to the start of ECC (extra corporeal circulation), and from the end of ECC to the end of blood stanching. They also received additional 5*10(5) KIU aprotinin in ECC prime volumes. 50 patients in Group C (Control) received neither aprotinin nor placebo. Bleeding after ECC (Group A: 315.7 +/- 203.1 ml, Group C: 484.3 +/- 598.5 ml p < 0.01), the first 6 hours drainage (Group A: 273.0 +/- 210.0 ml, Group C: 404.7 +/- 243.2 ml p < 0.01), the first 24 hours drainage (Group A: 510.2 +/- 248.0 ml, Group C: 721 +/- 317.7 ml p < 0.01) was significantly reduced in Group A. Amounts of homologous blood transfusion were significantly reduced in group A. (Group A: 4.7 +/- 5.3 units, Group C: 8.5 +/- 6.4 units p < 0.01). Among the patients with autologous blood transfusion, the rate of the patients without homologous transfusion was significantly higher in Group A (group A: 40/66 cases, Group C: 8/33 cases p < 0.01). The ECC time and the operation time was significantly shorter in Group A. There were 69 patients (Group A: 40, Group C: 29) whose ECC time was longer than 120 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)