Aprotinin in Children Undergoing Repair of Congenital Heart Defects

Abstract

Background Aprotinin use in adults is increasing, and its use in children has recently been reported. Methods The efficacy of aprotinin in children was tested in 80 children. Patients were in four groups: reoperations (59), neonates (8), extremely cyanotic children (6), and other complex repairs (7). The results were compared with those of 55 control infants and children: reoperations (25), neonates (10), cyanotic (10) and complex (10). Treatment groups were identical in age, sex ratio, cross-clamp time, and bypass time. Results Patients treated with aprotinin had a significant reduction in chest tube drainage (16.5 ± 9.8 versus 33.4 ± 22.1 mL · kg−1 · h−1; p < 0.001) and time to skin closure (64.2 ± 23.7 versus 80.1 ± 24.6 minutes; p < 0.001). Transfusion requirements were decreased in aprotinin-treated patients (4.2 ± 3.4 versus 6.7 ± 5.2 donors; p < 0.001). All of the control patients were exposed to at least one donor, whereas 10/80 (12.5%) of the aprotinin-treated group had no blood use (p < 0.006). There were no cases of renal insufficiency or allergic reactions in children receiving aprotinin. Three patients had thrombotic episodes: 2 superior vena caval problems and a lower extremity deep venous thrombosis. There were 3 cases of mediastinitis in the aprotinin group versus none in control patients (p < 0.05). Conclusions We conclude aprotinin is an effective means of reducing bleeding, operating time, and donor exposure in infants and children. An increased rate of thrombosis and possibly mediastinitis are potential problems. Aprotinin use in adults is increasing, and its use in children has recently been reported. The efficacy of aprotinin in children was tested in 80 children. Patients were in four groups: reoperations (59), neonates (8), extremely cyanotic children (6), and other complex repairs (7). The results were compared with those of 55 control infants and children: reoperations (25), neonates (10), cyanotic (10) and complex (10). Treatment groups were identical in age, sex ratio, cross-clamp time, and bypass time. Patients treated with aprotinin had a significant reduction in chest tube drainage (16.5 ± 9.8 versus 33.4 ± 22.1 mL · kg−1 · h−1; p < 0.001) and time to skin closure (64.2 ± 23.7 versus 80.1 ± 24.6 minutes; p < 0.001). Transfusion requirements were decreased in aprotinin-treated patients (4.2 ± 3.4 versus 6.7 ± 5.2 donors; p < 0.001). All of the control patients were exposed to at least one donor, whereas 10/80 (12.5%) of the aprotinin-treated group had no blood use (p < 0.006). There were no cases of renal insufficiency or allergic reactions in children receiving aprotinin. Three patients had thrombotic episodes: 2 superior vena caval problems and a lower extremity deep venous thrombosis. There were 3 cases of mediastinitis in the aprotinin group versus none in control patients (p < 0.05). We conclude aprotinin is an effective means of reducing bleeding, operating time, and donor exposure in infants and children. An increased rate of thrombosis and possibly mediastinitis are potential problems.