title: Is aprotinin indicated for reoperative valvular surgery?
abstract: OBJECTIVE
  While the hemostatic effect of aprotinin for patients undergoing reoperative coronary bypass is well established, it remains unclear whether these effects extend to patients undergoing reoperative valvular surgery.
  
  
  METHODS
  We examined our experience with 85 consecutive patients undergoing isolated reoperative valvular surgery with and without use of perioperative aprotinin in order to investigate differences in perioperative blood use, blood loss, bleeding complications, mortality and incidence of myocardial injury.
  
  
  RESULTS
  Aprotinin recipients benefited from a significant reduction in bleeding complications, and a decrease in perioperative and in-hospital mortalities as compared with untreated patients. Anaphylactic reactions and clinically significant thromboembolic events were not observed. There was no difference in the incidence of renal dysfunction or myocardial injury among aprotinin-treated and untreated groups.
  
  
  CONCLUSIONS
  Our results indicate that aprotinin therapy can be safely administered to patients undergoing reoperative valvular surgery. No increased incidence of anaphylactic reactions, renal dysfunction or perioperative myocardial injury was noted. The observed reductions in bleeding complications and perioperative and in-hospital mortality strongly warrant the evaluation of aprotinin for reoperative valvular surgery in a prospective fashion.
authors.affiliation: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Goldstein
authors.forename: C M
authors.initials: CM
authors.lastname: DeRosa
authors.forename: J A
authors.initials: JA
authors.lastname: Seldomridge
authors.forename: A D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis; D006351:Heart Valves / Q000601:surgery*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D007611:Aprotinin