Aprotinin in primary cardiac surgery: operative outcome of propensity score-matched study.
BACKGROUND
Some recent multicenter series have questioned the safety of aprotinin in primary cardiac operations. We report a large, single-center experience with aprotinin therapy in primary cardiac operations and discuss the limitations and potential confounders of current treatment strategies.


METHODS
We compared myocardial infarction, neurologic events, renal insufficiency, and operative death after first-time coronary or valve procedures, or both, in 3334 patients treated with full-dose aprotinin with 3417 patients not treated with aprotinin who underwent operation between March 1998 and January 2007. Further analysis was performed for 341 propensity score-matched pairs.


RESULTS
There were substantial differences between the groups. Aprotinin patients were higher risk on account of older age, unstable symptoms, poor ejection fraction, preoperative hemodynamic support, emergency/urgent operations, and combined coronary/valve operations. Postoperative bleeding and blood product transfusion were considerably reduced in aprotinin patients, as was median duration of mechanical ventilation. Aprotinin was neither a predictor of postoperative myocardial infarction, renal insufficiency, neurologic dysfunction, or operative death. Achieving parity between the groups by propensity score matching eliminated the elevated rates of postoperative renal insufficiency, neurologic dysfunction, and operative death observed in aprotinin patients in the unmatched comparison. These adverse outcomes were evenly distributed between matched groups. Conversely, blood transfusion had univariate associations with all adverse outcome measures.


CONCLUSIONS
Full-dose aprotinin use was not associated with myocardial infarction, neurologic dysfunction, renal insufficiency, or death after coronary or valve operations. We observed less postoperative bleeding and blood product transfusion, and early extubation with the use of aprotinin.
Ngaage
Dumbor L
DL
Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, United Kingdom. dngaage@yahoo.com
Cale
Alexander R
AR
Cowen
Michael E
ME
Griffin
Steven
S
Guvendik
Levant
L
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000401:mortality; D011183:Postoperative Complications / Q000139:chemically induced* / Q000401:mortality; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
D006490:Hemostatics; D007611:Aprotinin