| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;71:745-754
© 2001 The Society of Thoracic Surgeons
a Alexion Pharmaceuticals, Inc, New Haven, Connecticut, USA
b Cardiothoracic Anesthesia and Critical Care Department, Emory University Hospital, Atlanta, Georgia, USA
Address reprint requests to Dr Mojcik, Department of Clinical Development, Alexion Pharmaceuticals, Inc, 25 Science Park, Suite 360, New Haven, CT 06511
e-mail: mojcikc{at}alxn.com
Cardiopulmonary bypass is associated with a systemic inflammatory response, a spectrum of pathophysiologic changes ranging from mild organ dysfunction to multisystem organ failure. Complications include coagulation disorders (bleeding diathesis, hyperfibrinolysis) from platelet defects and plasmin activation, as well as pulmonary dysfunction from neutrophil sequestration and degranulation. Diverse injuries are a consequence of multiple inflammatory mediators (complement, kinins, kallikrein, cytokines). Both plasmin and kallikrein amplify the inflammatory response by activating components of the contact activation system. The full-Hammersmith (high dose) of aprotinin, a serine protease inhibitor approved for reducing blood loss and transfusion requirements in cardiopulmonary bypass, inhibits kallikrein and plasmin, resulting in suppression of multiple systems involved in the inflammatory response. Specifically, inhibition of factor XII, bradykinin, C5a, neutrophil integrin expression, elastase activity, and airway nitric oxide production are observed. Clinical correlates include reduced capillary leak, preserved systemic vascular resistance and blood pressure, and improved myocardial recovery following ischemia. Overall, evidence indicates that aprotinin attenuates the systemic inflammatory response associated with cardiopulmonary bypass.
This article has been cited by other articles:
|
|
 |
|
  T Okamura, N Ishibashi, Y Iwata, D Zurakowski, and R. Jonas Aprotinin concentration varies significantly according to cardiopulmonary bypass conditions Perfusion, November 1, 2008; 23(6): 355 - 360. [Abstract] [PDF]
|
|
|
|
 |
|
 O. Levionnois and P. Kronen Development of post-pump syndrome in a sheep after mitral valve stenting Lab Anim, October 1, 2008; 42(4): 505 - 510. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Mengistu, K. D. Rohm, J. Boldt, J. Mayer, S. W. Suttner, and S. N. Piper The Influence of Aprotinin and Tranexamic Acid on Platelet Function and Postoperative Blood Loss in Cardiac Surgery Anesth. Analg., August 1, 2008; 107(2): 391 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]
|
|
|
|
 |
|
 W. Dietrich, A. Ebell, R. Busley, and A.-L. Boulesteix Aprotinin and Anaphylaxis: Analysis of 12,403 Exposures to Aprotinin in Cardiac Surgery Ann. Thorac. Surg., October 1, 2007; 84(4): 1144 - 1150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. McEvoy, S. T. Reeves, J. G. Reves, and F. G. Spinale Aprotinin in Cardiac Surgery: A Review of Conventional and Novel Mechanisms of Action Anesth. Analg., October 1, 2007; 105(4): 949 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Furnary, Y. Wu, L. F. Hiratzka, G. L. Grunkemeier, and U. S. Page 3rd Aprotinin Does Not Increase the Risk of Renal Failure in Cardiac Surgery Patients Circulation, September 11, 2007; 116(11_suppl): I-127 - I-133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Levy and S. Force Invited commentary Ann. Thorac. Surg., September 1, 2007; 84(3): 986 - 987. [Full Text] [PDF]
|
|
|
|
|
|
D. Royston, J. H. Levy, J. Fitch, W. Dietrich, S. C. Body, J. M. Murkin, B. D. Spiess, and A. Nadel Full-Dose Aprotinin Use in Coronary Artery Bypass Graft Surgery: An Analysis of Perioperative Pharmacotherapy and Patient Outcomes Anesth. Analg., November 1, 2006; 103(5): 1082 - 1088. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Rosborough Cardiac Surgery in Elderly Patients: Strategies to Optimize Outcomes Crit. Care Nurse, October 1, 2006; 26(5): 24 - 31. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sedrakyan, A. Wu, G. Sedrakyan, M. Diener-West, M. Tranquilli, and J. Elefteriades Aprotinin use in thoracic aortic surgery: Safety and outcomes J. Thorac. Cardiovasc. Surg., October 1, 2006; 132(4): 909 - 917. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Kozik and J. S. Tweddell Characterizing the Inflammatory Response to Cardiopulmonary Bypass in Children Ann. Thorac. Surg., June 1, 2006; 81(6): S2347 - S2354. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Fischer and M. Steinhoff Effects of aprotinin on endothelium-dependent relaxation of large coronary arteries Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 801 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G Raja and G. D Dreyfus Modulation of Systemic Inflammatory Response after Cardiac Surgery Asian Cardiovasc Thorac Ann, December 1, 2005; 13(4): 382 - 395. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Hess Jr. Systemic inflammatory response to coronary artery bypass graft surgery Am. J. Health Syst. Pharm., September 15, 2005; 62(18_Supplement_4): S6 - S9. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Levy Overview of clinical efficacy and safety of pharmacologic strategies for blood conservation Am. J. Health Syst. Pharm., September 15, 2005; 62(18_Supplement_4): S15 - S19. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J Murphy, R. Ascione, and G. D Angelini Coronary artery bypass grafting on the beating heart: surgical revascularization for the next decade? Eur. Heart J., December 1, 2004; 25(23): 2077 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Khan, C. Bianchi, P. Voisine, J. Feng, J. Baker, M. Hart, M. Takahashi, G. Stahl, and F. W. Sellke Reduction of myocardial reperfusion injury by aprotinin after regional ischemia and cardioplegic arrest J. Thorac. Cardiovasc. Surg., October 1, 2004; 128(4): 602 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. K. Smith, S. K. Datta, L. H. Muhlbaier, G. Samsa, A. Nadel, and J. Lipscomb Cost analysis of aprotinin for coronary artery bypass patients: analysis of the randomized trials Ann. Thorac. Surg., February 1, 2004; 77(2): 635 - 642. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Tan, X. Sun, X. Zhu, Z. Zhang, J. Li, and Q. Shu Epidemiology of Nosocomial Pneumonia in Infants After Cardiac Surgery Chest, February 1, 2004; 125(2): 410 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Koster, S. Huebler, F. Merkle, T. Hentschel, M. Grundel, T. Krabatsch, L. Tambeur, M. Praus, H. Habazettl, W. M. Kuebler, et al. Heparin-Level-Based Anticoagulation Management During Cardiopulmonary Bypass: A Pilot Investigation on the Effects of a Half-Dose Aprotinin Protocol on Postoperative Blood Loss and Hemostatic Activation and Inflammatory Response Anesth. Analg., February 1, 2004; 98(2): 285 - 290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H Olivencia-Yurvati, N. Wallace, S. Ford, and R. T Mallet Leukocyte filtration and aprotinin: synergistic anti-inflammatory protection Perfusion, January 1, 2004; 19(1_suppl): S13 - S19. [Abstract] [PDF]
|
|
|
|
|
|
P. E. Greilich, C. F. Brouse, C. W. Whitten, L. Chi, J. M. DiMaio, and M. E. Jessen Antifibrinolytic therapy during cardiopulmonary bypass reduces proinflammatory cytokine levels: a randomized, double-blind, placebo-controlled study of {epsilon}-aminocaproic acid and aprotinin J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1498 - 1503. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Ngaage Off-pump coronary artery bypass grafting: the myth, the logic and the science Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 557 - 570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Levy and K. A. Tanaka Inflammatory response to cardiopulmonary bypass Ann. Thorac. Surg., February 1, 2003; 75(2): S715 - 720. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Bull and J. Maurer Aprotinin and preservation of myocardial function after ischemia-reperfusion injury Ann. Thorac. Surg., February 1, 2003; 75(2): S735 - 739. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Royston, T. Kovesi, and N. Marczin The unwanted response to cardiac surgery: Time for a reappraisal? J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 32 - 35. [Full Text] [PDF]
|
|
|
|
|
|
D. Schmartz, Y. Tabardel, J.-C. Preiser, L. Barvais, A. d'Hollander, J. Duchateau, and J.-L. Vincent Does aprotinin influence the inflammatory response to cardiopulmonary bypass in patients? J. Thorac. Cardiovasc. Surg., January 1, 2003; 125(1): 184 - 190. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Bailey, K. A. Tanaka, and J. H. Levy Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2003; 2(2003): 85 - 118. [Full Text]
|
|
|
|
|
|
A H Olivencia-Yurvati, C A Ferrara, N Tierney, N Wallace, and R T Mallet Strategic leukocyte depletion reduces pulmonary microvascular pressure and improves pulmonary status post-cardiopulmonary bypass Perfusion, January 1, 2003; 18(1_suppl): 23 - 31. [Abstract] [PDF]
|
|
|
|
|
|
L. Englberger, P. Markart, F.S. Eckstein, F.F. Immer, P.A. Berdat, and T.P. Carrel Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery Eur. J. Cardiothorac. Surg., October 1, 2002; 22(4): 545 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Tweddell, G. M. Hoffman, K. A. Mussatto, R. T. Fedderly, S. Berger, R. D. B. Jaquiss, N. S. Ghanayem, S. J. Frisbee, and S. B. Litwin Improved Survival of Patients Undergoing Palliation of Hypoplastic Left Heart Syndrome: Lessons Learned From 115 Consecutive Patients Circulation, September 24, 2002; 106(12_suppl_1): I-82 - I-89. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. B. Jaquiss, N. S. Ghanayem, M. C. Zacharisen, K. A. Mussatto, J. S. Tweddell, and S. B. Litwin Safety of Aprotinin Use and Re-Use in Pediatric Cardiothoracic Surgery Circulation, September 24, 2002; 106(12_suppl_1): I-90 - I-94. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Englberger, B. Kipfer, P. A. Berdat, U. E. Nydegger, and T. P. Carrel Aprotinin in coronary operation with cardiopulmonary bypass: does "low-dose" aprotinin inhibit the inflammatory response? Ann. Thorac. Surg., June 1, 2002; 73(6): 1897 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Chaney Corticosteroids and Cardiopulmonary Bypass : A Review of Clinical Investigations Chest, March 1, 2002; 121(3): 921 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. R. Conti and C. McQuitty Vasodilation and Cardiopulmonary Bypass : The Role of Bradykinin and the Pulmonary Vascular Endothelium Chest, December 1, 2001; 120(6): 1759 - 1761. [Full Text] [PDF]
|
|
|
|
|
|
J. H. Levy Pharmacologic preservation of the hemostatic system during cardiac surgery Ann. Thorac. Surg., November 1, 2001; 72(5): S1814 - 1820. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Greilich, K. Okada, P. Latham, R. R. Kumar, and M. E. Jessen Aprotinin But Not {epsilon}-Aminocaproic Acid Decreases Interleukin-10 After Cardiac Surgery With Extracorporeal Circulation: Randomized, Double-Blind, Placebo-Controlled Study in Patients Receiving Aprotinin and {epsilon}-Aminocaproic Acid Circulation, September 18, 2001; 104 (2009): I-265 - I-269. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
