[HSF] Aprotinin

[ebender001 at charter.net]

Two days ago I did an aortic valve, cabg on a 77 year old Jehovah's Witness patient.  She had drug eluting stents placed two months previously in the ramus and LAD.  She returned to the ER with an MI, a 90% ostial and 70% mid LAD stenosis, 70% ramus stenosis, and an aortic valve mean gradient of 50 mmHg.  Because of ongoing ischemia, an intra-aortic balloon pump was placed in the cath lab, resolving her chest pain and ST segment depression.  Her starting hematocrit was 33.  She would not accept blood under any circumstance.  The case went without a problem, and she had a post-op hematocrit of 31.  She transferred out of the ICU on post-op day 1 without any issues.  She developed shortness of breath and abdominal distention with a drop in blood pressure that night.  The bottom line is that she got a laparotomy this morning (post-op day 3) and had a deat right colon removed.

This is the only case in the last 10 years that I have used aprotinin, and I am wondering about causation.  She had an episode of atrial fib during the time she was developing shortness of breath.  TEE during the heart surgery showed no left atrial clot. The aortic annulus was not very calcified, requiring very little debridement.  I know the etiology of the dead bowel is not proveable, but I wonder about the effects of aprotinin.  Any comments?

Ed Bender, MD