Aprotinin therapy for insertion of ventricular assist devices for staged heart transplantation

Bleeding after insertion of ventricular assist devices is a common problem which carries a major risk of immediate and late complications. We evaluated the safety and efficacy of aprotinin in six patients undergoing staged heart transplantation and compared the results with those of six patients who received no aprotinin. The groups did not differ significantly with respect to age, gender, preoperative cause of cardiomyopathy, or cardiopulmonary bypass time. Patients treated with aprotinin had a significant reduction in postoperative chest tube drainage (743 +/- 457 versus 2036 +/- 1184 cc, respectively, for aprotinin therapy versus no therapy; p = 0.047). Blood transfusion requirements were reduced in patients treated with aprotinin (2.2 +/- 2.2 versus 10.7 +/- 7.1 U respectively, for aprotinin therapy versus no therapy; p = 0.038). No demonstrable serious side effects were attributed to the aprotinin treatment. We conclude that aprotinin is effective in reducing bleeding and transfusion requirements without increasing the incidence of clinically significant renal dysfunction or thromboembolic events.