[HSF] Fwd: STS MEMBER ALERT: FDA Issues Statement on UseofAprotinin (Tra...

[Cysmd613 at aol.com]

Last night I used aprotinin on a patient that I operated on for a Type A 
aortic dissection.  
66 yo man with untreated hypertension admitted to another hospital following 
a syncopal episode.  He had some atypical upper chest/lower neck pain.  He was 
found to be in afib.  Cardiac enzymes positive.  Started on plavix and 
aspirin.  Cardiac cath yesterday (36 hours later) showed no obstructive CAD, 3-4+ 
AI, good LV, and a dissection in the ascending aorta.  The cardiologist called 
me to transfer the patient.  CT scan was done which confirmed Type A dissection 
extending to level of the aortic valve and distally to the common iliacs.  
The arch appeared especially involved.  
At surgery, there was a tear in the mid ascending aorta, multiple ugly tears 
in the arch, and a chronic appearing flap just distal to the left subclavian 
artery.  I resuspended the valve with resultant no AI, and under deep 
hypothermic circ arrest replaced the ascending aorta and arch.  He is already 
extubated, neurologically intact and making good urine.  Creatinine is stable at 1.3 
(same as pre op).
In my pre op discussion with the patient and wife, I discussed with them that 
I was going to use aprotinin, and that there had been an FDA warning. 
As soon as I had opened the aortic arch and saw the extensive disease and 
crappy tissues, I was saying to myself that I should have flown the patient to 
Tom Martin!!!  However, thank G-d, the patient is doing well.
 
Carmi Stadlan



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