Safety of repeat aprotinin administration for LVAD recipients undergoing cardiac transplantation

Background. Anecdotal reports of allergic and anaphylactic reactions after aprotinin therapy have raised concern that its repeat use may be associated with substantial morbidity. Methods. To address this concern, we reviewed our experience with all patients who underwent implantation of a left ventricular assist device and subsequent cardiac transplantation with perioperative use of aprotinin. Results. Twenty-three patients received full-dose aprotinin during left ventricular assist device implantation and subsequent cardiac transplantation. All patients tolerated primary exposure to aprotinin without complication. One episode of anaphylaxis after secondary exposure was treated with rapid institution of cardiopulmonary bypass. Although renal dysfunction was observed shortly after cardiac transplantation in 30.4% of patients, the effect was transient and occurred in the presence of cyclosporine. The one perioperative death after secondary exposure was unrelated to bleeding complications. No clinically evident thromboembolic events were documented. Conclusions. Primary and secondary exposure to aprotinin during operation with cardiopulmonary bypass is associated with limited intraoperative blood use, a low incidence of transient renal dysfunction and anaphylaxis, a rare need of reoperation for bleeding, and no clinical thromboembolic events.