- Email: [email protected]
The impact of aprotinin on coronary artery bypass graft patency.
LITERATURE REVIEW Frederick W. Campbell, MD, Section Editor
SCIENTIFIC ARTICLES
Newman MF, Croughwell MD, Blumenthal JA, et ah Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction. Circulation 90:II-243-249, 1994 Nine measures of cognitive function were measured preoperatively and before hospital discharge in 215 patients undergoing coronary bypass surgery Pressure-flow and metabolic-flow cerebral autoregulatmn during hypothermlc cardiopulmonary bypass (CPB) were evaluated using i33Xe clearance determination of cerebral blood flow (CBF) and cerebral arterial venous oxygen content difference measurements at varying pressures or temperatures Pressure-flow autoregulation during hypothermic CPB showed a small but slgmficant effect of pressure on CBF There was no effect of age on the slope of CBF response to changes in arterial pressure. CBF was closely coupled with cerebral metabolic rate; this was unaffected by age Six of nine cognitive performance measures declined after surgery and were age related. Cognition changes were not associated with measures of cerebral autoregulatlon but were associated with increased cerebral oxygen extraction, suggesting that an imbalance in cerebral oxygen supply unrelated to age contributes to acute cognitive dysfunction.
McKenney PA, Apstein CS, Mendes LA, et al: Increased left ventricular diastolic chamber stiffness immediately after coronary artery bypass surgery. J Am Coil Cardio124:1189-1194, 1994 Simultaneous transesophageal echocardlographic and hemodynamlc monitoring were used to construct end-diastohc pressurearea curves before and immediately after coronary bypass surgery in 20 patients Loading conditions were manipulated by volume administration Dmstolic function decreased in all patients manifested by a postoperative leftward shift of the end-diastolic pressure-area curve At a comparable preload, mean end-diastolic area decreased by 15%.
Laub GW, Riebman JB, Chen C, et ah The impact of aprotinin on coronary artery bypass graft patency. Chest 106:1370-1375, 1994 In a prospective randomized double-bhnd trial, postoperative medlastmal drainage m high-dose aprotlnin-treated patients (N = 16) was less than that in control patients (N = 16) (722 v 1,540mL, p = 0.0006) Mean blood transfusion requlrementswere insignificantly reduced by aprotlnin treatment. Analysis of graft patency by ultrafast computed tomography scan 6 to 8 weeks postoperatively showed that five aprotmm paUents (31%) had at least one occluded graft, no control patients had an occluded graft (p = 0 04) Analysis by graft showed that 38 of 43 grafts in the
aprotlnln group were patent, all 38 grafts in the placebo group were patent (88.4% v 100%;p = 0 057). There was no difference in the incidence of myocardial infarction or renal dysfunction in the groups
Williams RD, D'Ambra MN, Maione TE, et ah Recombinant platelet factor 4 reversal of heparin in human cardiopulmonary bypass blood. J Thorac Cardiovasc Surg 108:975-983, 1994 Heparlnlzed human blood obtained from the bypass reservoir without reversal agents (control) or with either protamlne (10, 20, 30. or 40 Ixg/mL) or recombinant platelet factor 4 (10, 20, 40, or 80 ~g/mL) was analyzed by means of three standard whole blood coagulation tests" whole blood clotting time, heparln assay, and activated clotting time Recombinant platelet factor 4 reversed heparin at 40 p.g/mL and protamine at 20 txg/mL, suggestmg a reversal ratio for recombinant platelet factor 4/protamlne of 2 1 on a mllhgram basis Currently available methods for testing coagulation during cardlopulmonary bypass should be reliable to monitor restoration of hemostasls with recombinant platelet factor 4
De Caterina R, Lanza M, Manca G, et al: Bleeding time and bleeding: An analysis of the relationship of the bleeding time test with parameters of surgical bleeding. Blood 84:3363-3370, 1994 Duplicate bleeding time studies were obtained preoperatively in 40 patients with a negative bleeding history and no antlplatelet drug therapy. Neither bleeding time nor any of three parameters derived from the bleeding time test (total bleeding, peak bleeding rate, time to peak bleeding) correlated with indices of surgical and postoperative bleeding confirming previous analyses of the bleedmg time literature Bleeding time was increased by acute interventions with intravenous aspirin and subhngual nitroglycerin
Goldenberg IF, Lewis WR, Dias VC, et al: Intravenous diltiazem for the treatment of patients with atrial fibrillation or flutter and moderate to severe congestive heart failure. Am J Cardiol 74:884-889, 1994 Thirty-seven patients with rapid (ventrlcular rate 142 beats per minute) atrial fibrillation or flutter and moderate to severe congestive heart failure (mean ejection fraction, 36%) received either intravenous diltiazem, 0 25 mg/kg, or placebo followed 15 minutes later by 0.35 mg/kg of dlltlazem or placebo if the first dose was lneffectwe in a randomized double-blind study. Therapeutic response was achieved in 95% of dlltlazem-treated patients and none of the placebo patients. Open-label diltiazem administered to the 15 placebo nonresponders produced a therapeutic response in all patients Transient hypotenslon occurred in 11% of patients.
Journal of Cardlothoractc and Vascular Anesthesta, Vol 9, No 3 (June), 1995. pp 341-342
341
SCIENTIFIC ARTICLES
Newman MF, Croughwell MD, Blumenthal JA, et ah Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction. Circulation 90:II-243-249, 1994 Nine measures of cognitive function were measured preoperatively and before hospital discharge in 215 patients undergoing coronary bypass surgery Pressure-flow and metabolic-flow cerebral autoregulatmn during hypothermlc cardiopulmonary bypass (CPB) were evaluated using i33Xe clearance determination of cerebral blood flow (CBF) and cerebral arterial venous oxygen content difference measurements at varying pressures or temperatures Pressure-flow autoregulation during hypothermic CPB showed a small but slgmficant effect of pressure on CBF There was no effect of age on the slope of CBF response to changes in arterial pressure. CBF was closely coupled with cerebral metabolic rate; this was unaffected by age Six of nine cognitive performance measures declined after surgery and were age related. Cognition changes were not associated with measures of cerebral autoregulatlon but were associated with increased cerebral oxygen extraction, suggesting that an imbalance in cerebral oxygen supply unrelated to age contributes to acute cognitive dysfunction.
McKenney PA, Apstein CS, Mendes LA, et al: Increased left ventricular diastolic chamber stiffness immediately after coronary artery bypass surgery. J Am Coil Cardio124:1189-1194, 1994 Simultaneous transesophageal echocardlographic and hemodynamlc monitoring were used to construct end-diastohc pressurearea curves before and immediately after coronary bypass surgery in 20 patients Loading conditions were manipulated by volume administration Dmstolic function decreased in all patients manifested by a postoperative leftward shift of the end-diastolic pressure-area curve At a comparable preload, mean end-diastolic area decreased by 15%.
Laub GW, Riebman JB, Chen C, et ah The impact of aprotinin on coronary artery bypass graft patency. Chest 106:1370-1375, 1994 In a prospective randomized double-bhnd trial, postoperative medlastmal drainage m high-dose aprotlnin-treated patients (N = 16) was less than that in control patients (N = 16) (722 v 1,540mL, p = 0.0006) Mean blood transfusion requlrementswere insignificantly reduced by aprotlnin treatment. Analysis of graft patency by ultrafast computed tomography scan 6 to 8 weeks postoperatively showed that five aprotmm paUents (31%) had at least one occluded graft, no control patients had an occluded graft (p = 0 04) Analysis by graft showed that 38 of 43 grafts in the
aprotlnln group were patent, all 38 grafts in the placebo group were patent (88.4% v 100%;p = 0 057). There was no difference in the incidence of myocardial infarction or renal dysfunction in the groups
Williams RD, D'Ambra MN, Maione TE, et ah Recombinant platelet factor 4 reversal of heparin in human cardiopulmonary bypass blood. J Thorac Cardiovasc Surg 108:975-983, 1994 Heparlnlzed human blood obtained from the bypass reservoir without reversal agents (control) or with either protamlne (10, 20, 30. or 40 Ixg/mL) or recombinant platelet factor 4 (10, 20, 40, or 80 ~g/mL) was analyzed by means of three standard whole blood coagulation tests" whole blood clotting time, heparln assay, and activated clotting time Recombinant platelet factor 4 reversed heparin at 40 p.g/mL and protamine at 20 txg/mL, suggestmg a reversal ratio for recombinant platelet factor 4/protamlne of 2 1 on a mllhgram basis Currently available methods for testing coagulation during cardlopulmonary bypass should be reliable to monitor restoration of hemostasls with recombinant platelet factor 4
De Caterina R, Lanza M, Manca G, et al: Bleeding time and bleeding: An analysis of the relationship of the bleeding time test with parameters of surgical bleeding. Blood 84:3363-3370, 1994 Duplicate bleeding time studies were obtained preoperatively in 40 patients with a negative bleeding history and no antlplatelet drug therapy. Neither bleeding time nor any of three parameters derived from the bleeding time test (total bleeding, peak bleeding rate, time to peak bleeding) correlated with indices of surgical and postoperative bleeding confirming previous analyses of the bleedmg time literature Bleeding time was increased by acute interventions with intravenous aspirin and subhngual nitroglycerin
Goldenberg IF, Lewis WR, Dias VC, et al: Intravenous diltiazem for the treatment of patients with atrial fibrillation or flutter and moderate to severe congestive heart failure. Am J Cardiol 74:884-889, 1994 Thirty-seven patients with rapid (ventrlcular rate 142 beats per minute) atrial fibrillation or flutter and moderate to severe congestive heart failure (mean ejection fraction, 36%) received either intravenous diltiazem, 0 25 mg/kg, or placebo followed 15 minutes later by 0.35 mg/kg of dlltlazem or placebo if the first dose was lneffectwe in a randomized double-blind study. Therapeutic response was achieved in 95% of dlltlazem-treated patients and none of the placebo patients. Open-label diltiazem administered to the 15 placebo nonresponders produced a therapeutic response in all patients Transient hypotenslon occurred in 11% of patients.
Journal of Cardlothoractc and Vascular Anesthesta, Vol 9, No 3 (June), 1995. pp 341-342
341