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Heart Center of the University of Leipzig, Cardiovascular and Thoracic Surgery, Leipzig, Germany
Accepted for publication January 11, 2008.
* Address correspondence to Dr Bittner, Heart Center Leipzig, Struempellstr 39, Leipzig, 04289, Germany (Email: heartbeatgermany{at}aol.com).
Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 27–29, 2008.
Background: Administration of the serine protease inhibitor aprotinin has been proven efficacious in cardiopulmonary bypass–supported cardiac surgery to reduce bleeding and transfusion requirements. Its role in off-pump surgery is not so well defined. The present study assessed the effect of aprotinin in off-pump coronary artery bypass grafting on perioperative blood loss and transfusion rates.
Methods: A total of 761 consecutive adult patients who underwent off-pump coronary artery bypass grafting were retrospectively reviewed. The majority (87%) received aspirin preoperatively. Heparin was intravenously administered for a kaolin-based activated clotting time of greater than 300 seconds. Aprotinin was administered as a 1 million or 2 million kallikrein inhibiting unit bolus to 391 patients after median sternotomy. The control group (n = 370) underwent surgery during the same period without receiving aprotinin. Blood loss was measured intraoperatively (cell-saving device) and postoperatively by quantifying mediastinal chest tube drainage.
Results: Aprotinin was associated with a significant reduction in postoperative blood loss (p < 0.001) and less excessive postoperative hemorrhage (p < 0.001) compared with the control group. Transfusion rates and amount of blood products administered were also reduced by aprotinin (p < 0.01 for both). Significantly more patients in the aprotinin group were free of any blood product transfusion (54.7%) compared with the control group (41.4%; p < 0.01). The safety profile was comparable between aprotinin and control patients.
Conclusions: Aprotinin proved efficacious and safe in the reduction of postoperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting.
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