Aprotinin improves outcome of single-ventricle palliation

Elevation of pulmonary vascular resistance as a consequence of cardiopulmonary bypass may lead to failure of single-ventricle palliation. We reviewed our experience with aprotinin, a nonspecific serine protease inhibitor, to determine whether it could ameliorate the inflammatory effects of cardiopul...

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Bibliographic Details
Published in:	The Annals of thoracic surgery Vol. 62; no. 5; pp. 1329 - 1336
Main Authors:	Tweddell, James S., Berger, Stuart, Frommelt, Peter C., Pelech, Andrew N., Lewis, David A., Fedderly, Raymond T., Frommelt, Michele A., McManus, Terrence S., Mussatto, Kathleen A., Kessel, Maryanne W., Litwin, S. Bert
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 01-11-1996
Subjects:	Aprotinin - therapeutic use Child Child, Preschool Combined Modality Therapy Congenital Abnormalities - drug therapy Congenital Abnormalities - surgery Heart Bypass, Right - adverse effects Heart Ventricles - abnormalities Humans Infant Palliative Care Postoperative Care Pulmonary Circulation Retrospective Studies Serine Proteinase Inhibitors - therapeutic use Treatment Outcome Vascular Resistance
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Summary:	Elevation of pulmonary vascular resistance as a consequence of cardiopulmonary bypass may lead to failure of single-ventricle palliation. We reviewed our experience with aprotinin, a nonspecific serine protease inhibitor, to determine whether it could ameliorate the inflammatory effects of cardiopulmonary bypass and improve outcome of single-ventricle palliation. Forty-six consecutive patients undergoing single-ventricle palliation using cardiopulmonary bypass were reviewed retrospectively. Aprotinin was used in 8 of 30 bidirectional cavopulmonary shunt and 10 of 16 Fontan procedures. Aprotinin use was associated with a decrease in the early postoperative transpulmonary gradient among patients undergoing Fontan and bidirectional cavopulmonary shunt procedures. The bidirectional cavopulmonary shunt aprotinin group had a higher oxygen saturation and a decrease in quantity and duration of thoracic drainage. Among patients receiving aprotinin there were no episodes of mediastinitis, thrombus formation, or renal failure. Aprotinin use in single-ventricle palliation was associated with decreased transpulmonary gradient and increased oxygen saturation consistent with decreased pulmonary vascular resistance. This retrospective study suggests that aprotinin has a favorable impact on the early postoperative course of single-ventricle palliation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/0003-4975(96)00670-4