High-dose aprotinin modulates the balance between proinflammatory and anti-inflammatory responses during coronary artery bypass graft surgery.
OBJECTIVE
To rule out the effect of high-dose aprotinin in respect to the balance of proinflammatory and anti-inflammatory mediators induced by cardiopulmonary bypass (CPB).


METHODS
Randomized, double-blind, placebo-controlled study.


METHODS
University-affiliated cardiac center.


METHODS
Twenty patients scheduled for coronary artery bypass graft surgery.


METHODS
In group A patients (n = 10), high-dose aprotinin was administered (2 x 106 KIU pre-CPB, 2 x 10(6) KIU in prime, 500,000 KIU/hr during CPB). In group C patients (n = 10), placebo was used instead. Proinflammatory interleukin (IL)-6, anti-inflammatory IL-1-receptor antagonist, and clinical parameters were measured 8 times perioperatively. The values are presented as mean +/- SEM.


RESULTS
Four hours after CPB, IL-6 concentration reached the maximum value, being significantly lower in group A patients as compared with group C patients (615 +/- 62 pg/mL v 1,409 +/- 253 pg/mL; p = 0.019). On the first postoperative day, the concentration of IL-6 in group A patients remained lower (219 +/- 24 pg/mL v 526 +/- 123 pg/mL; p = 0.015). In contrast, IL-1-receptor antagonist concentration was higher in group A patients as compared with group C patients after CPB (13,857 +/- 4,264 pg/mL v 5,675 +/- 1,832 pg/mL; p = 0.03). Total postoperative blood loss was lower in group A patients as compared with group C patients (648 +/- 64 mL v 1,284 +/- 183 mL; p = 0.002).


CONCLUSIONS
High-dose aprotinin treatment reduced the inflammatory reaction and postoperative blood loss. The anti-inflammatory reaction was significantly enhanced in these patients, which suggests that the physiologic reaction of the organism to reduce the deleterious effects from CPB is more pronounced by using high-dose aprotinin.
Tassani
P
P
Institute of Anesthesiology, Department of Cardiac Surgery, Deutsches Herzzentrum, München, Germany.
Augustin
N
N
Barankay
A
A
Braun
S L
SL
Zaccaria
F
F
Richter
J A
JA
D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass; D004311:Double-Blind Method; D006439:Hemodynamics / Q000502:physiology; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D010100:Oxygen / Q000097:blood; D011184:Postoperative Period; D011446:Prospective Studies; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors
D006490:Hemostatics; D018836:Inflammation Mediators; D015850:Interleukin-6; D017472:Receptors, Interleukin-1; D007611:Aprotinin; D010100:Oxygen