A Comparative Study of Systemic Application vs. Topical Application of Aprotinin in Cardiac Surgery

The aim of this study was to make a comparative analysis between a regional and a systemic aprotinin use in coronary artery bypass grafting. The advantage of a topical aprotinin application is devoid of any systemic side effects. A randomized study & prospective in nature comprising ninety-seven patients was conducted. An average 5* 106 KIU aprotinin was given systemically to forty-nine patients and four doses of 1.25 times 106 KIU aprotinin in avg. were applied locally to forty eight patients by spraying the substance on the target (A. internal mamary region and pericardium). Markers for the inflammatory response, blood coagulation system, standard haematological markers were determined along with features of postoperative complications.

Patients having surgical bleeding, redo operations, neurological, bleeding disorders, hepatic and renal disorders were excluded. Sex, age, perfusion times, mortality, kidney failure and strokes were identical in both groups. Biochemical markers and clinical outcome demonstrated no significant differences between the generalised and localised applications. IL- 6 and serum elastase were found to be very higher (p= 0.1) within the topical group, but with a high variations in standard deviation in each patient. Our results suggest that there is absence of difference between the perioperative use of 5 106 KIU and systemically given aprotinin and 1.25 106 KIU which is locally applied aprotinin.