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Ann Thorac Surg 1996;62:1335-1336
© 1996 The Society of Thoracic Surgeons

Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 1329.

DR MEHMET C. OZ (New York, NY): There is an adult equivalent to this operation, and it is called a left ventricular assist device placement. We have done a similar analysis. We used aprotinin in 31 of 116 left ventricular assist device patients, and again many of them had true Fontan physiology with either arrhythmias or very poor right ventricular function. The anaphylaxis rate was low as you showed also, but the right ventricular assist device incidence was also lower in the aprotinin group than in the control group. Interestingly, the thromboembolic incidence was higher in the control group, I think because flows were often so low in these patients because they were bleeding. This translated to a significant 7-day mortality in the control group compared with the aprotinin group.

Aprotinin inhibits the detrimental inflammation effects of cardiopulmonary bypass and bleeding. I think it is not just the effects of cardiopulmonary bypass with neutrophil degranulation and thromboxane A2release that result in elevated pulmonary vascular resistance, but also the bleeding and resuscitation and resulting elevated circulating cytokines.

So my question for you is: Is there a patient in whom you would not use aprotinin? And do you have experience with redosing of aprotinin, and what do you do in that situation?

DR TWEDDELL: Thank you. None of the patients who underwent . . . [Full Text of this Article]


Related Article

Aprotinin Improves Outcome of Single-Ventricle Palliation
James S. Tweddell, Stuart Berger, Peter C. Frommelt, Andrew N. Pelech, David A. Lewis, Raymond T. Fedderly, Michele A. Frommelt, Terrence S. McManus, Ccp, Kathleen A. Mussatto, Maryanne W. Kessel, and S. Bert Litwin
Ann. Thorac. Surg. 1996 62: 1329-1335. [Abstract] [Full Text]





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Copyright © 1996 by The Society of Thoracic Surgeons.