[HSF] Aprotinin

[Hgrmd at aol.com]

Ben,
  Happy to comment.  I think both IABP and aprotinin are bad for  renal 
function.  However, IABP can kill the patient in myriad other  ways.  I've seen 
dead bowel, kidneys, and legs from IABP.  Therefore,  I advise my referrals to 
only insert the pump when there is truly critical  anatomy, refractory angina, 
or hemodynamic instability.  Unless a patient  has bounding pulses, I never 
prophylactically insert one for bad  ventricles.  However, I do place a 
percutaneous 18 gauge femoral arterial  line for more accurate monitoring, and to make 
it easy to insert an IABP if the  need should arise.  
  Dave's case where kidney function went south with an IABP and no  aprotinin 
certainly doesn't absolve the latter from being a cause of renal  failure.  
BTW, lawyers trolling the advertising media for "kidney failure  after cardiac 
surgery" continues to be a thriving industry in South  Florida.  I haven't 
heard of any actual lawsuits, but I'm sure they are  coming.  Sadly, I'd much 
prefer giving blood products than being  deposed.
 
Hal



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