Aprotinin to decrease bleeding and intraoperative blood transfusion requirements during descending thoracic and...

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Pharmacology

Background:

• Descending thoracic and thoracoabdominal aortic aneurysmectomy are complex procedures associated with significant bleeding.
• Cardiopulmonary bypass (CPB) is frequently employed, increasing risks of hemorrhage and transfusion.
• Antifibrinolytic agents may mitigate blood loss during major vascular surgery.

Purpose of the Study:

• To evaluate the efficacy of aprotinin in reducing bleeding and blood product requirements.
• To assess the impact of aprotinin on operative time and CPB duration in aortic aneurysm surgery.

Main Methods:

• Retrospective analysis of 69 patients undergoing thoracic or thoracoabdominal aortic aneurysmectomy with CPB.
• Comparison between a cohort not receiving aprotinin (n=29) and a cohort receiving high-dose aprotinin (n=40).
• Data collected included operative duration, CPB time, blood loss, and transfusion requirements.

Main Results:

• Aprotinin administration correlated with decreased CPB time (p=0.02) and surgical duration (p=0.05).
• Significant reduction in intraoperative blood loss (p=0.008) was observed with aprotinin.
• Aprotinin use led to decreased requirements for packed red blood cells (p=0.01), Cell-Saver units (p=0.05), fresh-frozen plasma (p=0.002), and platelet concentrates (p=0.01).

Conclusions:

• Aprotinin is effective in minimizing intraoperative bleeding during descending thoracic or thoracoabdominal aortic aneurysmectomy.
• The use of aprotinin significantly reduces the need for blood product transfusions in these high-risk surgical procedures.
• Aprotinin may be a valuable adjunct for optimizing outcomes in complex aortic surgeries involving CPB.