Efficacy and safety of aprotinin use for reoperative valvular surgery.
BACKGROUND
Preservation of the hemostatic system during cardiac surgery is a main concern, primarily after repeated cardiac operations.


METHODS
We compared the outcomes of adult patients undergoing isolated reoperative valvular surgery receiving full-dose of aprotinin (redo group, n = 70) with patients experiencing primary isolated valvular surgery not receiving aprotinin (primary group, n = 135).


RESULTS
The mean age was lower in the redo group (45 +/- 14 years vs 50 +/- 17 years, p = 0.036). The redo group had more female patients (73% vs 51%, p = 0.003), patients in functional class IV (15% vs 4% p = 0.009), and patients with chronic atrial fibrillation (48% vs 24%, p = 0.001). The cardiopulmonary bypass duration was longer in the redo group (119 +/- 50 minutes vs 103 +/- 41 minutes, p = 0.014). However, the blood loss was significantly lower (300 +/- 279 mL vs 776 +/- 584 mL, p = 0.001) and fewer patients needed transfusions (3.0% vs 13%, p = 0.023) in the redo group. The postoperative morbidity was similar in both groups. The postoperative in-hospital mortality was 7% in the primary group and 10% in the redo group (p = 0.419). Factors associated with postoperative in-hospital mortality were the following: age greater than 60 years (p = 0.040, odds ratio [OR] 3.0), New York Heart Association class IV (p = 0.022, OR 5.0), preoperative critical state (p < 0.001, OR 12), emergent operation (p = 0.012, OR 7.0), endocarditis (p = 0.004, OR 10.0), and reoperation due to mechanical mitral prosthesis dysfunction (p = 0.009, OR 7).


CONCLUSIONS
The mortality and morbidity in redo valve surgery with aprotinin administration was comparable with primary valve surgery without aprotinin. Bleeding and transfusion requirements were significantly lower in redo patients receiving aprotinin.
Rodrigues
Alfredo J
AJ
Division of Cardiothoracic Surgery, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. alfredo@fmrp.usp.br <alfredo@fmrp.usp.br>
Evora
Paulo Roberto B
PR
Bassetto
Solange
S
Luciano
Paula M
PM
Alves
Lafaiete
L
Filho
Adilson S
AS
Vicente
Walter Villela de Andrade
WV
D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000627:therapeutic use*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome
D006490:Hemostatics; D007611:Aprotinin