title: 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.
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Canada.
authors.forename: P A
authors.initials: PA
authors.lastname: Penkoske
authors.forename: L M
authors.initials: LM
authors.lastname: Entwistle
authors.forename: B E
authors.initials: BE
authors.lastname: Marchak
authors.forename: R F
authors.initials: RF
authors.lastname: Seal
authors.forename: W
authors.initials: W
authors.lastname: Gibb
mesh_terms: D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007611:Aprotinin