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Perfusion
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Topical application of aprotinin in cardiac surgery

Frank Isgro

Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany

Oliver Stanisch

Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany

Arndt-H Kiessling

Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany, kiesslia{at}klilu.de

Semih Gürler

Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany

Peter Hellstern

Institute of Hemostaseology and Transfusion Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany

Werner Saggau

Heart Institute Ludwigshafen, Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany

The aim of our study was to compare a systemic and a local aprotinin application in patients during coronary artery bypass graft (CABG) surgery. The advantage of a topical aprotinin application is seen in the fact that this may not lead to systemic side effects. A prospective, randomized study comprising 97 patients was conducted. A dose of 5 106 KIU aprotinin was given systemically to 49 patients and four doses of 1.25 106 KIU aprotinin were applied topically to 48 patients by spraying the substance on the target area (A. mammaria interna region and pericardium). We determined markers for the inflammatory response, coagulation system, standard haematological markers and postoperative complications. Exclusion criteria were defined as surgical bleeding, redo operations, neurological, haematological, liver and kidney disorders. Sex, age, perfusion times, mortality, renal failure and strokes were identical in both groups. Biochemical markers and clinical outcome demonstrated no significant differences between the systemic and local applications. Interleukin 6 and elastase were tendentially higher (p= 0.1) in the local group, but with a high standard deviation in each patient. Our results suggest that there is no difference between the perioperative application of 5 106 KIU systemically given aprotinin and 1.25 106 KIU locally applied aprotinin.

Perfusion, Vol. 17, No. 5, 347-351 (2002)
DOI: 10.1191/0267659102pf596oa
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