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Ann Thorac Surg 1993;55:1460-1466
© 1993 The Society of Thoracic Surgeons

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Articles

Aprotinin in pediatric cardiac operations: Platelet function, blood loss, and use of homologous blood

Department of Anesthesiology and Intensive Care Medicine and Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Germany

Accepted for publication September 10, 1992.

^_* Address reprint requests to Prof Dr Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikstr. 29, Justus-Liebig-University Giessen, D-6300 Giessen, Germany.

Excessive hemorrhage secondary to cardiopulmonary bypass may be encountered after pediatric cardiac operations. Platelet dysfunction appears to be especially responsible for this problem. The proteinase inhibitor aprotinin is suggested to possess platelet preservation properties and reduce blood loss in this situation. The effects of aprotinin (25,000 U/kg after induction of anesthesia, 25,000 U/kg added to the prime, 25,000 U/kg every hour of cardiopulmonary bypass) on platelet function were randomly studied in 12 children with a weight of less than 10 kg (group 2) and 12 children weighing more than 10 kg (group 4), who were compared with two groups of children without aprotinin (group 1, <10 kg; group 3, >10 kg). Twelve children undergoing major vessel operations without cardiopulmonary bypass and aprotinin served as a control. Platelet function was assessed using aggregometry (turbidometric technique with adenosine diphosphate, 2.0 µmol/L; collagen, 4 µg/mL; epinephrine, 25 Mµmol/L; NaCl [control]). Platelet function was not altered in the control patients within the entire investigation period. Maximum aggregation in the small children was already lower at baseline in comparison with that of the children >10 kg. Cardiopulmonary bypass was followed by a significant reduction in platelet aggregation in all groups. Treatment with aprotinin did not improve platelet function (maximum aggregation and maximum gradient of aggregation) in any group. On the first postoperative day, maximum aggregation in the small children exceeded baseline values, whereas in both groups of children >10 kg baseline values had almost been established. Postoperative blood loss was not reduced by treatment with aprotinin. On the first postoperative day, blood loss in group 3 (>10 kg, with aprotinin) was highest. Total use of packed red cells and fresh frozen plasma was higher in both aprotinin-treated groups. We conclude that aprotinin was without positive influence on platelet aggregation and postoperative blood loss in small and in bigger children undergoing cardiac operations. The reasons for the reduced platelet function in the small children need further investigation.

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