Desmopressin does not reduce bleeding and transfusion requirements in congenital heart operations.
BACKGROUND
Desmopressin (DDAVP) has been evaluated in many randomized clinical trials as a means to reduce blood loss and transfusion of allogeneic blood in cardiac operation requiring cardiopulmonary bypass. Desmopressin reduces blood loss in adult patients with excessive bleeding after cardiac operation. Its usefulness in patients undergoing complex congenital heart repair with cardiopulmonary bypass is unproved.


METHODS
Sixty patients younger than 40 years of age scheduled for complex congenital heart operation (44 redo, 16 primary) were enrolled in this prospective, randomized, double-blind trial. Desmopressin 0.3 microg/kg or placebo was administered 10 minutes after protamine administration. Transfusion requirements and postoperative blood loss were recorded. Differences were analyzed using analysis of variance with a p value of 0.05 or less used to denote statistical significance.


RESULTS
There were no differences in demographic or surgical characteristics between the DDAVP or placebo groups. There was no difference in blood loss and transfusion requirements between the DDAVP and placebo groups. During the intraoperative postinfusion time period, the median blood loss for redo patients was 343 versus 357 mL/m2 for placebo versus DDAVP, respectively, and for primary patients, the median blood loss was 277 versus 228 mL/m2.


CONCLUSIONS
The prophylactic use of DDAVP to reduce excessive bleeding or transfusion requirements in patients undergoing complex congenital heart operations is not warranted.
Oliver
W C
WC
Department of Anesthesiology, Mayo Foundation, Rochester, Minnesota 55905, USA. oliver.william@mayo.edu
Santrach
P J
PJ
Danielson
G K
GK
Nuttall
G A
GA
Schroeder
D R
DR
Ereth
M H
MH
D000293:Adolescent; D000328:Adult; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012086:Reoperation
D003894:Deamino Arginine Vasopressin