High-dose aprotinin reduces systemic inflammatory response syndrome during CABG

Objectives

During pediatric cardiopulmonary bypass (CPB), low-dose aprotinin has been shown not to influence the systemic inflammatory response syndrome (SIRS). It is well established that aprotinin has beneficial influence on postoperative blood loss during cardiac surgery. Thus, the aim of this study was to rule out the effect of high-dose aprotinin in respect to SIRS and clinical parameters in adult patients.

Methods

In this prospective, randomized, double-blind, placebo-controlled study, twenty patients were enrolled. In Group A patients (n = 10), high-dose aprotinin was administered (2 Mio KIU pre-bypass, 2 Mio KIU in prime, 0.5 Mio KIU/h during CPB). In Group C patients (n = 10) no aprotinin was used. Pro-inflammatory interleukin-6, anti-inflammatory interleukin-10, and clinical parameters were measured six times perioperatively. The values are presented as mean ± SEM.

Results

Four hours after CPB interleukin-6 concentration reached the maximum value being significantly lower in Group A patients as compared to Group C patients (615 ± 62 vs 1409 ± 252 pg/ml, respectively; P = 0.019). At the first postoperative day the concentration of interleukin-6 in Group A patients remained lower (218 ± 23 vs 526 ± 123 pg/ml, respectively; P = 0.015). In contrast interleukin-10 concentration was higher in Group A patients as compared to Group C patients after CPB (265 ± 91 vs 59 ± 13pg/ml, respectively; P = 0.03). Postoperative blood loss was lower in Group A patients as compared to the Group C patients (648 ± 64 vs 1284 ± 183 ml, respectively; P = 0.002).

Conclusions

High-dose aprotinin treatment caused significantly less SIRS and reduced postoperative blood loss after CPB. Anti-inflammatory reaction was significantly enhanced in these patients, which suggests that the physiological reaction of the organism to reduce deleterious effects to CPB is strengthened by using high-dose aprotinin.