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J Thorac Cardiovasc Surg 2007;134:1426-1428
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr James S. Tweddell (Milwaukee, Wis). That was an excellent presentation, Carl, as usual. This is a timely contribution from the group at Children’s Memorial Hospital. The authors looked at their entire experience with aprotinin, a period of 6 years, and compared this with the previous 6-year period. Just over 2000 patients are included, pretty much evenly divided between the use and nonuse of aprotinin, making this the largest single-center report concerning aprotinin use in pediatrics by far.

Despite an increase in case complexity in the most recent aprotinin cohort, there is no difference in mortality or renal impairment, suggesting that aprotinin use is safe in this age group. Incidentally, our aprotinin use policy is identical to yours.

The limitations of this study have been acknowledged by the authors and most importantly include the comparison of noncontemporary patient groups. I would contend that this is a form of selection bias.

This study begins in 1994, and just for some perspective, in 1994, the sitcom "Friends" premiered on NBC, Netscape 1.0 was released, and George Bush was unequivocally elected governor of Texas. Times have changed.

Since 1994, we have seen some important changes in various aspects of preoperative, intraoperative, and postoperative management of patients with congential heart disease, including some pioneered from your institution.

Taking the devil’s advocate position, one could argue that your most recent results, which are excellent, would have been even better if you had not used aprotinin. Therefore my comments and questions are really directed at potential ways around this time–bias issue.

The most recent studies from the Ischemia Research and Education Foundation purported to show that aprotinin use was associated with a significantly increased risk of complications in adults—myocardial infarction, stroke and renal failure—in patients not having complex operations. Could you or did you . . . [Full Text of this Article]

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Aprotinin is safe in pediatric patients undergoing cardiac surgery

Carl L. Backer, Angela M. Kelle, Robert D. Stewart, Sunitha C. Suresh, Farah N. Ali, Richard A. Cohn, Roopa Seshadri, and Constantine Mavroudis
J. Thorac. Cardiovasc. Surg. 2007 134: 1421-1428. [Abstract] [Full Text] [PDF]