The use of aprotinin in children undergoing operative repair of isolated atrial septal defects.
BACKGROUND
The purpose of this retrospective study was to examine the benefits, risks and costs associated with aprotinin use in children who underwent repair of an atrial septal defect (ASD). The primary aim was to determine whether the transfusion rate is lower in children who received aprotinin compared with those who did not during ASD repair. The use of aprotinin has been shown to reduce transfusion requirements for children undergoing primary or secondary repair of congenital cardiac anomalies. However, past studies have not reported the benefits of this agent during low complexity procedures such as ASD repair.


METHODS
All children who underwent ASD repair over 6 years (3 years pre- and postroutine use of aprotinin for all CPB cases in the institution) were identified, and their medical records reviewed. Children with multiple congenital cardiac lesions were excluded. The following data were recorded: demographics and baseline laboratory findings, intraoperative use of aprotinin, cardiopulmonary bypass information including details of ultrafiltration, all intraoperative and postoperative transfusions, postoperative bleeding and relevant laboratory findings.


RESULTS
One hundred and fifteen children were included, 66 of whom received aprotinin. Transfusion rates were not different between children who received aprotinin [n = 8 (12%)] and those who did not [n = 3 (6%)]. Furthermore, changes in hematocrit were not different between groups. These findings were similar when children </=15 kg were compared with those >15 kg.


CONCLUSIONS
This study suggests that aprotinin use offers no benefit for children undergoing isolated repair of an ASD.
Chiravuri
S Devi
SD
Department of Anesthesiology and Surgery, University of Michigan Health Systems, Ann Arbor, MI 48109-5211, USA. devich@umich.edu
Voepel-Lewis
Terri
T
Devaney
Eric J
EJ
Malviya
Shobha
S
D007611:Aprotinin / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D012189:Retrospective Studies
D006490:Hemostatics; D007611:Aprotinin