Abstract 2325: The Use of Aprotinin in Cardiac Surgery is Associated with Increased Risk of Renal Failure and Neurologic Events
Introduction Aprotinin use has recently been linked to greater rates of perioperative complications. In the light of our routine use of aprotinin we reviewed our institutional use of aprotinin and the subsequent rates of complications following open-heart surgery.
Methods We reviewed all adult cardiac surgical cases (n=8,018) performed between 2001 and 2005. Patients with history of renal failure or hemodialysis were excluded. Patients were grouped into four independent groups: control (no aprotinin or amicar, n=2,153); amicar only (1,087); Half dose aprotinin (n=1,138); and full dose aprotinin (n=3,640). Odds ratios (OR) and 95% confidence intervals (CI) are reported after adjustment for different risk factors.
Results: The operative mortality and morbidity were comparable to the national average as presented by the STS database. However, when testing for predictors of adverse outcome, the use of aprotinin found to be significant. The use of half-dose aprotinin was a significant predictor of prolonged ventilation time (OR=2.10, 95%=1.56–2.83), atrial fibrillation (OR=2.38, 95%=1.81–3.13), reoperation for bleeding (OR=4.70, 95%CI=2.84–7.97)), and renal failure (OR=2.76, 95% CI=1.82–4.18). The use of high-dose aprotinin was a significant predictor of permanent stroke (OR=3.08, 95% CI= 1.62–5.85), prolonged ventilation time (OR=1.76, 95% CI=1.38–2.25)), atrial fibrillation (OR=2.31, 95% CI= 1.84–2.89), reoperation for bleeding (OR=4.05, 95% CI=2.56–6.40), and renal failure (OR=1.98, 95% CI=1.38–2.85), dialysis required (OR=2.37, 95% CI=1.37–4.08) and 30-day mortality (1.67, 95% CI=1.12–2.52). After adjustment, a one unit increase of aprotinin per kilogram was a significant predictor of perioperative stroke (OR=1.09, 95% CI=1.01–1.17), prolonged ventilation time (OR=1.03, 95% CI=1.01–1.06), dialysis required (OR=1.04, 95% CI=1.00–1.09), and 30-day mortality (OR=1.07, 95% CI=1.04–1.11).
Conclusions: Although our operative results are comparable to the published data in the STS database, the use of aprotinin was found to be associated with increased rates of perioperative complications. In light of this, the benefits of continued routine use of aprotinin must be carefully weighed against the potential risks.