Aprotinin in cardiac surgery – a postoperative outcome analysis

Aims: Aprotinin is used to reduce bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. Actually the use of aprotinin is negatively influenced by safety concerns regarding increased morbidity and mortality. Therefore we sought to determine the impact of aprotinin on safety variables among 1206 cardiac surgery patients in a single-center analysis. Method: We performed a retrospective analysis with multivariate logistic regression, including propensity score adjustment and matching comprising cardiac surgery patients operated with cardiopulmonary bypass over a 1-years period. A 4-year follow-up was completed. Propensity matched pairs analysis observed 538 control patients and 343 aprotinin patients with comparable pre- and intraoperative variables. Results: High-dose aprotinin significantly reduced postoperative blood loss (p<0.001) and transfusion requirements (p=0.009). Aprotinin did not affect the occurrence of myocardial infarction (p=0.9), renal failure (p=0.09), stroke (p=0.9), delirium (p=0.7) or death (p=0.4). In multivariate logistic regression aprotinin was not identified as a risk factor for postoperative cardiac or non-cardiac morbidity, postoperative acute renal failure, readmission to the ICU, or mortality. The 1, 2, 3, and 4-year survival for the Aprotinin patients was 86.3%, 84.9%, 82.0%, 80.6%, for the control patients 89.9%, 86.7%, 85.6% and 85.2% respectively. Long-term survival showed no statistical difference between the groups. Conclusion: These data suggest that the administration of aprotinin to cardiac surgery patients does not increase the risk of myocardial infarction, renal failure, stroke or death. Also the long-term survival is not affected by aprotinin. Aprotinin represents an important and safe approach for blood conservation in cardiac surgery without adverse events.