[HSF] More Bad News About Trasylol

[Ben Bidstrup]

Hal,
The literature has many references to the incidence of ESR failure 
leading to dialysis after cardiac surgery. There are many risk 
assessments, with factors such as inotrope use, red cell transfusion 
and pre-existing renal impairment. The paper from Cooper ( Cooper, 
W.A., et al., Impact of renal dysfunction on outcomes of coronary 
artery bypass surgery: results from the Society of Thoracic Surgeons 
National Adult Cardiac Database. Circulation, 2006. 113(8): p. 
1063-70. )suggests that of all CABG patients (STS Database data n = 
483,914) the incidence of new renal dialysis was 1.5%. After AVR, I 
have no data but it may be similar. Thus 3 in 200 will get RF needing 
dialysis. Maybe this was one of those 3. To relate a problem to 1 
case is to draw a long bow, but cardiac surgeons are known for their 
prowess in archery. Especially getting the bull in the first shot.
Need to also define renal failure, ATN etc. See this paper (Kuitunen, 
A., et al., Acute renal failure after cardiac surgery: evaluation of 
the RIFLE classification. Ann Thorac Surg, 2006. 81(2): p. 542-6.)

BTW have seen an amazing fireworks display, not in a cardiac OR but 
on Victoria Harbour, Hong Kong.



>Prasanna,
>   I'm glad you've never seen permanent ESRD with aprotinin--I  have.  In
>fact, what tipped me off many years ago that aprotinin produced  ATN was a
>completely uneventful, easy AVR that I did on an old lady receiving 
>aprotinin. 
>After she went on the pump, she never made a drop of urine,  absolutely zero. 
>Otherwise, she did OK, but she ended up on permanent  HD.  I had 
>never even heard
>of aprotinin-associated ATN, but this  definitely made me suspicious. Most of
>the aprotinin-associated ATN does  resolve, but some does not.  As we all
>know, ATN with dialysis requires  invasive lines that can get infected. 
>Antibiotics can lead to C.  dif.  Etc, etc. 
>Hal
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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon