Aprotinin improves outcome of single-ventricle palliation.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53201, USA.
J S
JS
Tweddell
S
S
Berger
P C
PC
Frommelt
A N
AN
Pelech
D A
DA
Lewis
R T
RT
Fedderly
M A
MA
Frommelt
T S
TS
McManus
K A
KA
Mussatto
M W
MW
Kessel
S B
SB
Litwin
D007611:Aprotinin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D000013:Congenital Abnormalities / Q000188:drug therapy / Q000601:surgery; D018610:Heart Bypass, Right / Q000009:adverse effects*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D010166:Palliative Care; D011182:Postoperative Care; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014655:Vascular Resistance
D015842:Serine Proteinase Inhibitors; D007611:Aprotinin