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Aprotinin in children undergoing repair of congenital heart defects
P A Penkoske1, L M Entwistle, B E Marchak
1Department of Surgery, University of Alberta, Edmonton, Canada.
Insights
Aprotinin effectively reduces bleeding, surgery duration, and blood transfusions in pediatric patients. However, potential risks include increased thrombosis and mediastinitis.
Area of Science:
- Pediatric Cardiac Surgery
- Pharmacology
- Hemostasis Management
Background:
- Aprotinin (a serine protease inhibitor) use is growing in adults and has been recently explored in pediatric populations.
- Pediatric cardiac surgery often involves significant blood loss, necessitating transfusions and prolonged operating times.
Purpose of the Study:
- To evaluate the efficacy and safety of aprotinin in pediatric patients undergoing cardiac surgery.
- To assess the impact of aprotinin on blood loss, transfusion requirements, and operative time in children.
Main Methods:
- A prospective study involving 80 pediatric patients treated with aprotinin, categorized into reoperations, neonates, cyanotic children, and complex repairs.
- Comparison with a control group of 55 pediatric patients who did not receive aprotinin.
- Analysis of chest tube drainage, time to skin closure, and transfusion requirements.
Main Results:
- Aprotinin significantly reduced chest tube drainage (16.5 vs. 33.4 mL.kg-1.h-1) and time to skin closure (64.2 vs. 80.1 minutes).
- Transfusion requirements were lower in the aprotinin group (4.2 vs. 6.7 donors), with 12.5% of treated patients avoiding blood use entirely.
- No renal insufficiency or allergic reactions were observed; however, 3 thrombotic events and 3 cases of mediastinitis occurred in the aprotinin group.
Conclusions:
- Aprotinin demonstrates efficacy in reducing bleeding, operative time, and blood product exposure in pediatric cardiac surgery.
- Potential risks associated with aprotinin use in children include an increased incidence of thrombosis and mediastinitis.
Background:
Aprotinin use in adults is increasing, and its use in children has recently been reported.
Methods:
The efficacy of aprotinin in children was tested in 80 children. Patients were in four groups: reoperations (59), neonates (8), extremely cyanotic children (6), and other complex repairs (7). The results were compared with those of 55 control infants and children: reoperations (25), neonates (10), cyanotic (10) and complex (10). Treatment groups were identical in age, sex ratio, cross-clamp time, and bypass time.
Results:
Patients treated with aprotinin had a significant reduction in chest tube drainage (16.5 +/- 9.8 versus 33.4 +/- 22.1 mL.kg-1.h-1; p < 0.001) and time to skin closure (64.2 +/- 23.7 versus 80.1 +/- 24.6 minutes; p < 0.001). Transfusion requirements were decreased in aprotinin-treated patients 4.2 +/- 3.4 versus 6.7 +/- 5.2 donors; p < 0.001). All of the control patients were exposed to at least one donor, whereas 10/80 (12.5%) of the aprotinin-treated group had no blood use (p < 0.006). There were no cases of renal insufficiency or allergic reactions in children receiving aprotinin. Three patients had thrombotic episodes: 2 superior vena caval problems and a lower extremity deep venous thrombosis. There were 3 cases of mediastinitis in the aprotinin group versus none in control patients (p < 0.05).
Conclusions:
We conclude aprotinin is an effective means of reducing bleeding, operating time, and donor exposure in infants and children. An increased rate of thrombosis and possibly mediastinitis are potential problems.