Defining the role of aprotinin in heart transplantation

Thomas W. Prendergast, Satoshi Furukawa, A. James Beyer, Howard J. Eisen, James B. McClurken, Valluvan Jeevanandam

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background. Heart transplantation is associated with excessive bleeding due to recipient coagulopathy, frequent need for reoperative median sternotomy, and prolonged cardiopulmonary bypass. Aprotinin reduces bleeding and the inflammatory response after cardiopulmonary bypass, but there are concerns about efficacy and side effects. Methods. To determine the role of aprotinin in primary and reoperative sternotomy heart transplantation, we studied 70 patients undergoing heart transplantation between August 1993 and October 1994. Thirty-eight undergoing primary sternotomy for heart transplantation and receiving no aprotinin were randomized to group A (n = 20); patients in group B (n = 18) received the full recommended dose. Similarly, 32 patients undergoing reoperative heart transplantation were randomized to group C (n = 16), receiving no aprotinin, and to group D (n = 16), receiving aprotinin at the full recommended dose. All patients received the same immunosuppression regimen. Similarities in the groups included recipient age, weight, preoperative hemodynamic indices, creatinine, creatinine clearance, platelet count, hemoglobin, percentage receiving warfarin, prothrombin time, partial thromboplastin time, cardiopulmonary bypass time, and creatinine level at 48 hours. Results. There were no significant differences postoperatively between groups A and E. Differences (p < 0.05) 24 hours postoperatively between groups C and D, respectively, included: total blood product requirement (5.9 ± 3.8 versus 3.6 ± 2.0 U), total fluid balance (+752 ± 300 versus -250 ± 185 mL), chest tube drainage (894 ± 120 versus 526 ± 95 mL), alveolar-arterial O2 difference (120.4 ± 45.9 versus 95.5 ± 33.5), and pulmonary artery mean pressures (28.2 ± 4.6 versus 21.1 ± 3.5 mm Hg). Conclusions. Aprotinin decreases bleeding after reoperative heart transplantation without renal dysfunction. Decreased inflammation is manifested as reduced fluid requirement and improved pulmonary and right heart function, which benefit patients during the posttransplantation period. Aprotinin at recommended doses is effective and safe for patients undergoing reoperative heart transplantation.

Original languageEnglish (US)
Pages (from-to)670-674
Number of pages5
JournalAnnals of Thoracic Surgery
Volume62
Issue number3
DOIs
StatePublished - Sep 1996

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Aprotinin
Heart Transplantation
Sternotomy
Cardiopulmonary Bypass
Creatinine
Hemorrhage
Chest Tubes
Water-Electrolyte Balance
Partial Thromboplastin Time
Prothrombin Time
Warfarin
Platelet Count
Immunosuppression
Pulmonary Artery
Drainage
Hemoglobins
Hemodynamics
Inflammation
Kidney
Pressure

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Prendergast, T. W., Furukawa, S., Beyer, A. J., Eisen, H. J., McClurken, J. B., & Jeevanandam, V. (1996). Defining the role of aprotinin in heart transplantation. Annals of Thoracic Surgery, 62(3), 670-674. https://doi.org/10.1016/S0003-4975(96)00436-5
Prendergast, Thomas W. ; Furukawa, Satoshi ; Beyer, A. James ; Eisen, Howard J. ; McClurken, James B. ; Jeevanandam, Valluvan. / Defining the role of aprotinin in heart transplantation. In: Annals of Thoracic Surgery. 1996 ; Vol. 62, No. 3. pp. 670-674.
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abstract = "Background. Heart transplantation is associated with excessive bleeding due to recipient coagulopathy, frequent need for reoperative median sternotomy, and prolonged cardiopulmonary bypass. Aprotinin reduces bleeding and the inflammatory response after cardiopulmonary bypass, but there are concerns about efficacy and side effects. Methods. To determine the role of aprotinin in primary and reoperative sternotomy heart transplantation, we studied 70 patients undergoing heart transplantation between August 1993 and October 1994. Thirty-eight undergoing primary sternotomy for heart transplantation and receiving no aprotinin were randomized to group A (n = 20); patients in group B (n = 18) received the full recommended dose. Similarly, 32 patients undergoing reoperative heart transplantation were randomized to group C (n = 16), receiving no aprotinin, and to group D (n = 16), receiving aprotinin at the full recommended dose. All patients received the same immunosuppression regimen. Similarities in the groups included recipient age, weight, preoperative hemodynamic indices, creatinine, creatinine clearance, platelet count, hemoglobin, percentage receiving warfarin, prothrombin time, partial thromboplastin time, cardiopulmonary bypass time, and creatinine level at 48 hours. Results. There were no significant differences postoperatively between groups A and E. Differences (p < 0.05) 24 hours postoperatively between groups C and D, respectively, included: total blood product requirement (5.9 ± 3.8 versus 3.6 ± 2.0 U), total fluid balance (+752 ± 300 versus -250 ± 185 mL), chest tube drainage (894 ± 120 versus 526 ± 95 mL), alveolar-arterial O2 difference (120.4 ± 45.9 versus 95.5 ± 33.5), and pulmonary artery mean pressures (28.2 ± 4.6 versus 21.1 ± 3.5 mm Hg). Conclusions. Aprotinin decreases bleeding after reoperative heart transplantation without renal dysfunction. Decreased inflammation is manifested as reduced fluid requirement and improved pulmonary and right heart function, which benefit patients during the posttransplantation period. Aprotinin at recommended doses is effective and safe for patients undergoing reoperative heart transplantation.",
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Prendergast, TW, Furukawa, S, Beyer, AJ, Eisen, HJ, McClurken, JB & Jeevanandam, V 1996, 'Defining the role of aprotinin in heart transplantation', Annals of Thoracic Surgery, vol. 62, no. 3, pp. 670-674. https://doi.org/10.1016/S0003-4975(96)00436-5

Defining the role of aprotinin in heart transplantation. / Prendergast, Thomas W.; Furukawa, Satoshi; Beyer, A. James; Eisen, Howard J.; McClurken, James B.; Jeevanandam, Valluvan.

In: Annals of Thoracic Surgery, Vol. 62, No. 3, 09.1996, p. 670-674.

Research output: Contribution to journalArticle

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T1 - Defining the role of aprotinin in heart transplantation

AU - Prendergast, Thomas W.

AU - Furukawa, Satoshi

AU - Beyer, A. James

AU - Eisen, Howard J.

AU - McClurken, James B.

AU - Jeevanandam, Valluvan

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N2 - Background. Heart transplantation is associated with excessive bleeding due to recipient coagulopathy, frequent need for reoperative median sternotomy, and prolonged cardiopulmonary bypass. Aprotinin reduces bleeding and the inflammatory response after cardiopulmonary bypass, but there are concerns about efficacy and side effects. Methods. To determine the role of aprotinin in primary and reoperative sternotomy heart transplantation, we studied 70 patients undergoing heart transplantation between August 1993 and October 1994. Thirty-eight undergoing primary sternotomy for heart transplantation and receiving no aprotinin were randomized to group A (n = 20); patients in group B (n = 18) received the full recommended dose. Similarly, 32 patients undergoing reoperative heart transplantation were randomized to group C (n = 16), receiving no aprotinin, and to group D (n = 16), receiving aprotinin at the full recommended dose. All patients received the same immunosuppression regimen. Similarities in the groups included recipient age, weight, preoperative hemodynamic indices, creatinine, creatinine clearance, platelet count, hemoglobin, percentage receiving warfarin, prothrombin time, partial thromboplastin time, cardiopulmonary bypass time, and creatinine level at 48 hours. Results. There were no significant differences postoperatively between groups A and E. Differences (p < 0.05) 24 hours postoperatively between groups C and D, respectively, included: total blood product requirement (5.9 ± 3.8 versus 3.6 ± 2.0 U), total fluid balance (+752 ± 300 versus -250 ± 185 mL), chest tube drainage (894 ± 120 versus 526 ± 95 mL), alveolar-arterial O2 difference (120.4 ± 45.9 versus 95.5 ± 33.5), and pulmonary artery mean pressures (28.2 ± 4.6 versus 21.1 ± 3.5 mm Hg). Conclusions. Aprotinin decreases bleeding after reoperative heart transplantation without renal dysfunction. Decreased inflammation is manifested as reduced fluid requirement and improved pulmonary and right heart function, which benefit patients during the posttransplantation period. Aprotinin at recommended doses is effective and safe for patients undergoing reoperative heart transplantation.

AB - Background. Heart transplantation is associated with excessive bleeding due to recipient coagulopathy, frequent need for reoperative median sternotomy, and prolonged cardiopulmonary bypass. Aprotinin reduces bleeding and the inflammatory response after cardiopulmonary bypass, but there are concerns about efficacy and side effects. Methods. To determine the role of aprotinin in primary and reoperative sternotomy heart transplantation, we studied 70 patients undergoing heart transplantation between August 1993 and October 1994. Thirty-eight undergoing primary sternotomy for heart transplantation and receiving no aprotinin were randomized to group A (n = 20); patients in group B (n = 18) received the full recommended dose. Similarly, 32 patients undergoing reoperative heart transplantation were randomized to group C (n = 16), receiving no aprotinin, and to group D (n = 16), receiving aprotinin at the full recommended dose. All patients received the same immunosuppression regimen. Similarities in the groups included recipient age, weight, preoperative hemodynamic indices, creatinine, creatinine clearance, platelet count, hemoglobin, percentage receiving warfarin, prothrombin time, partial thromboplastin time, cardiopulmonary bypass time, and creatinine level at 48 hours. Results. There were no significant differences postoperatively between groups A and E. Differences (p < 0.05) 24 hours postoperatively between groups C and D, respectively, included: total blood product requirement (5.9 ± 3.8 versus 3.6 ± 2.0 U), total fluid balance (+752 ± 300 versus -250 ± 185 mL), chest tube drainage (894 ± 120 versus 526 ± 95 mL), alveolar-arterial O2 difference (120.4 ± 45.9 versus 95.5 ± 33.5), and pulmonary artery mean pressures (28.2 ± 4.6 versus 21.1 ± 3.5 mm Hg). Conclusions. Aprotinin decreases bleeding after reoperative heart transplantation without renal dysfunction. Decreased inflammation is manifested as reduced fluid requirement and improved pulmonary and right heart function, which benefit patients during the posttransplantation period. Aprotinin at recommended doses is effective and safe for patients undergoing reoperative heart transplantation.

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Prendergast TW, Furukawa S, Beyer AJ, Eisen HJ, McClurken JB, Jeevanandam V. Defining the role of aprotinin in heart transplantation. Annals of Thoracic Surgery. 1996 Sep;62(3):670-674. https://doi.org/10.1016/S0003-4975(96)00436-5