Aprotinin is safe in pediatric patients undergoing cardiac surgery

Carl L Backer*, Angela M. Kelle, Robert D. Stewart, Sunitha C. Suresh, Farah N. Ali, Richard A Cohn, Roopa Seshadri, Constantine Mavroudis

*Corresponding author for this work

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objective: Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass. Methods: We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994-1999, when aprotinin was not used (n = 1230), with a cohort from 2000-2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate. Results: The aprotinin group was younger (mean age, 3.49 ± 1.84 vs 3.64 ± 4.75 years; P = .019) and had a higher Aristotle score (7.8 ± 2.3 vs 7.2 ± 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5%] vs 47 [3.8%], P = .508), acute kidney failure (68 [6.0%] vs 69 [5.7%], P = .77), need for temporary dialysis (6 [0.49%] vs 12 [0.96%], P = .17), or neurologic complications (14 [1.1%] vs 17 [1.4%], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078). Conclusion: In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.

Original languageEnglish (US)
Pages (from-to)1421-1428
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume134
Issue number6
DOIs
StatePublished - Dec 1 2007

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Aprotinin
Thoracic Surgery
Pediatrics
Cardiopulmonary Bypass
Acute Kidney Injury
Mortality
Nervous System
Dialysis
Multivariate Analysis
Regression Analysis
Serine Proteinase Inhibitors
Cohort Studies
Retrospective Studies
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Backer, Carl L ; Kelle, Angela M. ; Stewart, Robert D. ; Suresh, Sunitha C. ; Ali, Farah N. ; Cohn, Richard A ; Seshadri, Roopa ; Mavroudis, Constantine. / Aprotinin is safe in pediatric patients undergoing cardiac surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 134, No. 6. pp. 1421-1428.
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title = "Aprotinin is safe in pediatric patients undergoing cardiac surgery",
abstract = "Objective: Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass. Methods: We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994-1999, when aprotinin was not used (n = 1230), with a cohort from 2000-2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate. Results: The aprotinin group was younger (mean age, 3.49 ± 1.84 vs 3.64 ± 4.75 years; P = .019) and had a higher Aristotle score (7.8 ± 2.3 vs 7.2 ± 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5{\%}] vs 47 [3.8{\%}], P = .508), acute kidney failure (68 [6.0{\%}] vs 69 [5.7{\%}], P = .77), need for temporary dialysis (6 [0.49{\%}] vs 12 [0.96{\%}], P = .17), or neurologic complications (14 [1.1{\%}] vs 17 [1.4{\%}], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078). Conclusion: In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.",
author = "Backer, {Carl L} and Kelle, {Angela M.} and Stewart, {Robert D.} and Suresh, {Sunitha C.} and Ali, {Farah N.} and Cohn, {Richard A} and Roopa Seshadri and Constantine Mavroudis",
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Backer, CL, Kelle, AM, Stewart, RD, Suresh, SC, Ali, FN, Cohn, RA, Seshadri, R & Mavroudis, C 2007, 'Aprotinin is safe in pediatric patients undergoing cardiac surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 134, no. 6, pp. 1421-1428. https://doi.org/10.1016/j.jtcvs.2007.08.006

Aprotinin is safe in pediatric patients undergoing cardiac surgery. / Backer, Carl L; Kelle, Angela M.; Stewart, Robert D.; Suresh, Sunitha C.; Ali, Farah N.; Cohn, Richard A; Seshadri, Roopa; Mavroudis, Constantine.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 134, No. 6, 01.12.2007, p. 1421-1428.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Aprotinin is safe in pediatric patients undergoing cardiac surgery

AU - Backer, Carl L

AU - Kelle, Angela M.

AU - Stewart, Robert D.

AU - Suresh, Sunitha C.

AU - Ali, Farah N.

AU - Cohn, Richard A

AU - Seshadri, Roopa

AU - Mavroudis, Constantine

PY - 2007/12/1

Y1 - 2007/12/1

N2 - Objective: Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass. Methods: We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994-1999, when aprotinin was not used (n = 1230), with a cohort from 2000-2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate. Results: The aprotinin group was younger (mean age, 3.49 ± 1.84 vs 3.64 ± 4.75 years; P = .019) and had a higher Aristotle score (7.8 ± 2.3 vs 7.2 ± 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5%] vs 47 [3.8%], P = .508), acute kidney failure (68 [6.0%] vs 69 [5.7%], P = .77), need for temporary dialysis (6 [0.49%] vs 12 [0.96%], P = .17), or neurologic complications (14 [1.1%] vs 17 [1.4%], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078). Conclusion: In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.

AB - Objective: Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass. Methods: We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994-1999, when aprotinin was not used (n = 1230), with a cohort from 2000-2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate. Results: The aprotinin group was younger (mean age, 3.49 ± 1.84 vs 3.64 ± 4.75 years; P = .019) and had a higher Aristotle score (7.8 ± 2.3 vs 7.2 ± 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5%] vs 47 [3.8%], P = .508), acute kidney failure (68 [6.0%] vs 69 [5.7%], P = .77), need for temporary dialysis (6 [0.49%] vs 12 [0.96%], P = .17), or neurologic complications (14 [1.1%] vs 17 [1.4%], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078). Conclusion: In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.

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