Aprotinin in Neonates Undergoing Cardiopulmonary Bypass

NCT ID: NCT00469742

Last Updated: 2012-03-16

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 290 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2007-04-30
• Study Completion Date: 2008-12-31

Brief Summary

This is a retrospective chart review study. The purpose of this study is to review our experience at Children's Healthcare of Atlanta in neonates receiving aprotinin. We will examine the specific outcomes of renal dysfunction, thrombosis and mortality.

Detailed Description

Aprotinin (Trasylol; Bayer Corporation, Pittsburgh, PA), a serine protease inhibitor isolated from bovine lung, is used intra-operatively during cardiac surgery to reduce bleeding. It is thought to work by inhibiting the contact activation phase of the coagulation cascade, reducing thrombin generation, preventing fibrinolysis and attenuating cardiopulmonary bypass (CPB)-induced platelet dysfunction.Though the efficacy of aprotinin in reducing blood loss in adults undergoing CPB is well established, its safety profile, specifically its association with renal dysfunction, thrombosis and long-term mortality, has been questioned. Although the homeostatic derangements of CPB are more significant in pediatric patients, its efficacy and safety profiles in this patient population are actually less clear. In children undergoing re-operative cardiac surgical procedures, aprotinin has been shown to be effective in attenuating post-bypass coagulopathies and decreasing blood product exposure (4). However, little information is available for neonates undergoing CPB who receive intra-operative aprotinin especially in terms of renal dysfunction and thrombosis.

All neonates who underwent Cardiopulmonary Bypass surgery (CPB) at Children's Healthcare of Atlanta between March 1, 2004 and March 1, 2007 will be candidates for this retrospective chart review. Notations will be made regarding those who received aprotinin and those who did not. Primary end points will include post-operative renal dysfunction, need for temporary dialysis, thrombosis and in-hospital mortality. Post -operative renal dysfunction will be defined as a doubling of the pre-operative creatinine level within the first 72 hours after surgery. Thrombosis found during the initial hospitalization will be considered significant. Chart review will gather demographic data (age, weight and type of surgery) as well as other data including CPB time, aortic cross clamp time, presence of regional perfusion, lowest temperature on CPB, time to chest closure, hours with a NIRS value below 40 in the first 24 hours post-op, highest recorded lactate value, blood products administered in the first 24 hours post-op, chest tube drainage in the first 24 hours post-op, first post-op weight, time to extubation and time to ICU discharge.

Conditions

Cardiopulmonary Bypass; Congenital Defects; Hemostasis

Study Design

• Study Time Perspective: RETROSPECTIVE

Eligibility Criteria

Inclusion Criteria

• Neonates who underwent Cardiopulmonary Bypass (CPB) at Children's Healthcare of Atlanta between March 2004 and March 2007.

• Maximum Eligible Age: 1 Month
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Children's Healthcare of Atlanta

OTHER

Sponsor Role: lead

Responsible Party

Children's Healthcare of Atlanta Institutional Review Board

Principal Investigators

Nina Guzzetta, MD

Role: PRINCIPAL_INVESTIGATOR

Emory University

Locations

Children's Healthcare of Atlanta

Atlanta, Georgia, United States

Countries

United States

References

Dietrich W, Spath P, Zuhlsdorf M, Dalichau H, Kirchhoff PG, Kuppe H, Preiss DU, Mayer G. Anaphylactic reactions to aprotinin reexposure in cardiac surgery: relation to antiaprotinin immunoglobulin G and E antibodies. Anesthesiology. 2001 Jul;95(1):64-71; discussion 5A-6A. doi: 10.1097/00000542-200107000-00015.

Reference Type: BACKGROUND

PMID: 11465586 (View on PubMed)

Arnold DM, Fergusson DA, Chan AK, Cook RJ, Fraser GA, Lim W, Blajchman MA, Cook DJ. Avoiding transfusions in children undergoing cardiac surgery: a meta-analysis of randomized trials of aprotinin. Anesth Analg. 2006 Mar;102(3):731-7. doi: 10.1213/01.ane.0000194954.64293.61.

Reference Type: BACKGROUND

PMID: 16492820 (View on PubMed)

Mangano DT, Miao Y, Vuylsteke A, Tudor IC, Juneja R, Filipescu D, Hoeft A, Fontes ML, Hillel Z, Ott E, Titov T, Dietzel C, Levin J; Investigators of The Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery. JAMA. 2007 Feb 7;297(5):471-9. doi: 10.1001/jama.297.5.471.

Reference Type: BACKGROUND

PMID: 17284697 (View on PubMed)

Miller BE, Tosone SR, Tam VK, Kanter KR, Guzzetta NA, Bailey JM, Levy JH. Hematologic and economic impact of aprotinin in reoperative pediatric cardiac operations. Ann Thorac Surg. 1998 Aug;66(2):535-40; discussion 541. doi: 10.1016/s0003-4975(98)00469-x.

Reference Type: BACKGROUND

PMID: 9725399 (View on PubMed)

Other Identifiers

07-020

Identifier Type: -

Identifier Source: org_study_id