Aprotinin and perioperative complications in cardiac surgery

M. D. Kertai, K. S. Varga, D. Royston, M. J. London, Z. Szabolcs, C. R. Grebenik, G. Acsady, J. Gal

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Aim. Recently, the clinical significance of aprotinin-induced renal dysfunction and other end-organ complications in patients undergoing cardiac surgery has engendered substantial controversy. Therefore, we assessed the effect of aprotinin on end-organ complications in patients undergoing cardiac surgery. Methods. Data of 674 patients (mean age 65.4±11.0 years, 457 males) undergoing cardiac surgery between January 1 and December 31, 2005 at Semmelweis University were used for the analyses. Preoperative, intraoperative and postoperative clinical and surgical variables were recorded. Patients administered aprotinin received the drug either as a low-dose regimen, a loading dose of 1 million kallikrein-inhibitor units (KIU), 1 million KIU in pump, and 1 million KIU post pump (or continuous infusion of 0.25 million KIU per hour); or a high-dose regimen, a loading dose of 2 million KIU, 2 million KIU in pump, and 2 million KIU post pump (or continuous infusion of 0.5 million KIU per hour). The outcomes were renal complications defined as a 25% reduction in postoperative calculated creatinine clearance compared to the preoperative baseline or renal failure requiring dialysis; and the composite of renal, cardiovascular and cerebrovascular complications and all-cause mortality. Results. Patients underwent coronary artery bypass surgery (63%), valvular (27%) or a combination (5%) and surgery on the ascending aorta (5%). There were 550 patients (81.6%) who received aprotinin treatment. In multivariate regression analyses when the relation between high or low dose aprotinin compared to no aprotinin was evaluated, the likelihood of renal complications [high dose: odds ratio (OR)=l.4, 95% confidence interval (CI), 0.6-3.0, P=0.4; low dose: OR=l.2, 95% CI, 0.7-2.3, p=0.51, and the composite outcome variable (high dose: OR=1.6, 95% CI, 0.8-3.4, P=0.2; low dose: OR=1.3, 95% CI, 0.7-2.3, P=0.4) were not significantly increased. Conclusion. Our analysis suggests that aprotinin use in either a high of low dose regimen was not associated with an increase in adverse end-organ complications.

Original languageEnglish
Pages (from-to)761-772
Number of pages12
JournalJournal of Cardiovascular Surgery
Volume48
Issue number6
Publication statusPublished - Dec 1 2007

Keywords

  • Aprotinin
  • Cardiac surgical procedures
  • Intraoperative complications

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Kertai, M. D., Varga, K. S., Royston, D., London, M. J., Szabolcs, Z., Grebenik, C. R., Acsady, G., & Gal, J. (2007). Aprotinin and perioperative complications in cardiac surgery. Journal of Cardiovascular Surgery, 48(6), 761-772.