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J Thorac Cardiovasc Surg 1998;116:373-374
© 1998 Mosby, Inc.

Letters To The Editor

Aprotinin

Frank A. Baciewicz, Jr., MD

To the Editor:

I enjoyed the recent article "Operations on the Thoracic Aorta and Hypothermic Circulatory Arrest: Is Aprotinin Safe?" in the January 1998 issue of the Journal (1998;115:220-5).

I have not used full-dose aprotinin in patients requiring hypothermic circulatory arrest since early 1994. Two female patients had repair of type I aortic dissection with hypothermic circulatory arrest periods of 32 and 40 minutes, respectively. Over the next 3 days, both patients had progressive hypoxemia, which did not respond to positive end-expiratory pressure, increasing inspired oxygen fraction, and varying modes of ventilation. The chest x-ray film in both patients was clear. Both patients had good cardiac status after the operation, normal renal function, and intact neurologic function. Both patients received blood and blood products. Because of this pulmonary problem, I have not used aprotinin with hypothermic circulatory arrest, and I have not had a recurrence of this problem.

Did the authors compare arterial oxygen tension, levels of positive end-expiratory pressure, inspired oxygen fraction, chest x-ray films, duration of ventilatory support, and incidence of pneumonia in the aprotinin and non-aprotinin groups?

Department of Cardiothoracic SurgeryWayne State University–Harper Hospital, 3990 John R., Ste. 2120, Detroit, MI 4820112/8/90666





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