• Christophe Bert, Frederik De Buck, Paul Sergeant, Jan Van Hemelrijck, Ahmad Kasran, Victor Van Duppen, Jan Ceuppens, Bart Meyns, Michel Delforge, and Patrick Wouters.
• Department of Anesthesiology, University Hospital Gasthuisberg, Leuven, Belgium. christophe.bert@olvz-aalst.be
• J. Cardiothorac. Vasc. Anesth. 2008 Feb 1;22(1):16-22.

ObjectivesIn addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting.DesignA prospective randomized clinical trial.SettingUniversity hospital.ParticipantsFifty patients were randomized to control (n = 25) or aprotinin treatment (n = 25) groups.InterventionsAprotinin was given as a loading dose (2 x 10(6) KIU) followed by a continuous infusion at 5 x 10(5) KIU/h until skin closure.Measurements And Main ResultsBlood samples for cardiac troponin I; interleukin-6, interleukin-8, and interleukin-10; tumor necrosis factor alpha; and elastase were taken after anesthesia induction, completion of revascularization, and 6 hours, 12 hours, and 24 hours after revascularization. Blood samples were taken to assess for apoptosis in polymorphonuclear cells. Baseline plasma levels for cardiac troponin I did not differ between groups but were significantly lower in aprotinin-treated patients at the time of revascularization (p = 0.03) and 6 hours (p = 0.004) and 24 hours (p = 0.03) later. Aprotinin significantly reduced apoptosis in polymorphonuclear cells compared with control-treated patients (p = 0.04). There were no differences in plasma cytokine or elastase levels between groups.ConclusionsThe authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery.

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