ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2008;86:354-355. doi:10.1016/j.athoracsur.2008.01.006
© 2008 The Society of Thoracic Surgeons
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Douglas West
Dhruva Prakash
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by West, D.
Right arrow Articles by Prakash, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by West, D.
Right arrow Articles by Prakash, D.
Related Collections
Right arrow Lung - cancer
Right arrowRelated Article

Correspondence

Aprotinin and Extrapleural Pneumonectomy

Douglas West, BS, MB, Dhruva Prakash, MS, MCh

Department of Thoracic Surgery, Hairmyres Hospital, Eaglesham Rd, East Kilbride, Scotland, G75 8RG United Kingdom

(Email: dgwest{at}rcsed.ac.uk).

To the Editor:

We read with interest the article from Dr Bakaeen and coworkers at M. D. Anderson Cancer Center reporting their experience with aprotinin in extrapleural pneumonectomy (EPP) [1]. Although they did not show significant differences in patient blood loss or survival with the use of aprotinin, we believe that aprotinin may well have beneficial effects in this patient population.

We have performed 75 EPP procedures in our institution since 1987. Demographics were similar to the M. D. Anderson experience, with a mean age of 59.3 (SD, 7.2) years, and 54 of 75 (72%) were men. In 1992, we began to use a perioperative intravenous infusion of aprotinin (Trasylol, Bayer AG, Leverkusen Germany), and have continued this practice since. We routinely infused aprotinin at a rate of 500,000 U/h from the beginning of the operation and for 1 to 2 hours into the postoperative period.

Retrospective analysis of our data shows that the earlier no-aprotinin group bled more intraoperatively (2523 [SD, 1403] mL) than the later aprotinin group (2092 [SD, 701] mL) but that this did not reach statistical significance on unpaired t test (p = 0.102). Survival analysis of the aprotinin vs no-aprotinin group again showed a nonsignificant trend towards improved survival with aprotinin (median survival, 17.7 vs 5.8 months; hazard ratio for death, 0.68; log-rank, p = 0.09), although aprotinin use did not emerge as an independent predictor in our Cox proportional hazards model of survival. Renal dysfunction was documented in 1 of 38 no-aprotinin and 2 of 37 aprotinin patients (p = 0.94).

Extrapleural pneumonectomy involves significant blood loss, and reported postprocedural morbidity rates remain high [2]. Both Dr Bakaeen's group and ours have relatively few patients available for analysis and are potentially confounded by learning curve effects because aprotinin was used in the latter parts of both series. We have used a full-dose aprotinin regimen, and this might explain why the trend towards decreased blood loss was more marked in our series. In neither group has a statistically significant improvement in survival or blood loss been demonstrated. Nevertheless, in our view, the trends towards decreased blood loss, lower transfusion, and improved survival seen in these small series justify the continued study of aprotinin use during EPP, pending the reporting of larger series. As Dr Bakaeen and colleagues suggest, straightforward extrapolation of the recent studies of aprotinin use in cardiac surgery [3] to the unusual situation of EPP surgery may be overly simplistic and deny patients a potentially beneficial therapy.


   References
Top
 References
 

  1. Bakaeen FG, Rice D, Correa AM, et al. Use of aprotinin in extrapleural pneumonectomy: effect on hemostasis and incidence of complications Ann Thorac Surg 2007;84:982-987.[Abstract/Free Full Text]
  2. Sugarbaker DJ, Jaklitsch MT, Bueno R, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies J Thorac Cardiovasc Surg 2004;128:138-146.[Abstract/Free Full Text]
  3. Mangano DT, Tudor IC, Dietzel C. The risk associated with aprotinin in cardiac surgery N Engl J Med 2006;354:353-365.[Abstract/Free Full Text]

Related Article

Reply
Faisal G. Bakaeen and David Rice
Ann. Thorac. Surg. 2008 86: 355. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
F. G. Bakaeen and D. Rice
Reply.
Ann. Thorac. Surg., July 1, 2008; 86(1): 355 - 355.
[Full Text] [PDF]

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Douglas West
Dhruva Prakash
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by West, D.
Right arrow Articles by Prakash, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by West, D.
Right arrow Articles by Prakash, D.
Related Collections
Right arrow Lung - cancer
Right arrowRelated Article

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