In Nordic countries 30-day mortality rate is half that estimated with EuroSCORE II in high-risk adult patients given aprotinin and undergoing mainly complex cardiac procedures
van der Linden, Jan; Fux, Thomas; Kaakinen, Timo; Rutanen, Juha; Toivonen, Jenni M; Nyström, Fredrik; Wahba, Alexander; Hammas, Bengt; Parviainen, Maria; Cunha-Goncalves, Doris; Hiippala, Seppo (2024-03-31)
Taylor & Francis
31.03.2024
Jan van der Linden, Thomas Fux, Timo Kaakinen, Juha Rutanen, Jenni M. Toivonen, Fredrik Nyström, Alexander Wahba, Bengt Hammas, Maria Parviainen, Doris Cunha-Goncalves & Seppo Hiippala (2024) In Nordic countries 30-day mortality rate is half that estimated with EuroSCORE II in high-risk adult patients given aprotinin and undergoing mainly complex cardiac procedures, Scandinavian Cardiovascular Journal, 58:1, DOI: 10.1080/14017431.2024.2330347
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© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
https://creativecommons.org/licenses/by-nc/4.0/
© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
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Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:oulu-202404022504
https://urn.fi/URN:NBN:fi:oulu-202404022504
Tiivistelmä
Abstract
Objectives:
To describe current on- (isolated coronary arterty bypass grafting, iCABG) and off-label (non-iCABG) use of aprotinin and associated safety endpoints in adult patients undergoing high-risk cardiac surgery in Nordic countries.
Design:
Data come from 10 cardiac surgery centres in Finland, Norway and Sweden participating in the European Nordic aprotinin patient registry (NAPaR).
Results:
486 patients were given aprotinin between 2016 and 2020. 59 patients (12.1%) underwent iCABG and 427 (87.9%) non-iCABG, including surgery for aortic dissection (16.7%) and endocarditis (36.0%). 89.9% were administered a full aprotinin dosage and 37.0% were re-sternotomies. Dual antiplatelet treatment affected 72.9% of iCABG and 7.0% of non-iCABG patients. 0.6% of patients had anaphylactic reactions associated with aprotinin. 6.4% (95 CI% 4.2%–8.6%) of patients were reoperated for bleeding. Rate of postoperative thromboembolic events, day 1 rise in creatinine >44μmol/L and new dialysis for any reason was 4.7% (95%CI 2.8%–6.6%), 16.7% (95%CI 13.4%–20.0%) and 14.0% (95%CI 10.9%–17.1%), respectively. In-hospital mortality and 30-day mortality was 4.9% (95%CI 2.8%–6.9%) and 6.3% (95%CI 3.7%–7.8%) in all patients versus mean EuroSCORE II 11.4% (95%CI 8.4%–14.0%, p < .01). 30-day mortality in patients undergoing surgery for aortic dissection and endocarditis was 6.2% (95%CI 0.9%–11.4%) and 6.3% (95%CI 2.7%–9.9%) versus mean EuroSCORE II 13.2% (95%CI 6.1%–21.0%, p = .11) and 14.5% (95%CI 12.1%–16.8%, p = .01), respectively.
Conclusions:
NAPaR data from Nordic countries suggest a favourable safety profile of aprotinin in adult cardiac surgery.
Objectives:
To describe current on- (isolated coronary arterty bypass grafting, iCABG) and off-label (non-iCABG) use of aprotinin and associated safety endpoints in adult patients undergoing high-risk cardiac surgery in Nordic countries.
Design:
Data come from 10 cardiac surgery centres in Finland, Norway and Sweden participating in the European Nordic aprotinin patient registry (NAPaR).
Results:
486 patients were given aprotinin between 2016 and 2020. 59 patients (12.1%) underwent iCABG and 427 (87.9%) non-iCABG, including surgery for aortic dissection (16.7%) and endocarditis (36.0%). 89.9% were administered a full aprotinin dosage and 37.0% were re-sternotomies. Dual antiplatelet treatment affected 72.9% of iCABG and 7.0% of non-iCABG patients. 0.6% of patients had anaphylactic reactions associated with aprotinin. 6.4% (95 CI% 4.2%–8.6%) of patients were reoperated for bleeding. Rate of postoperative thromboembolic events, day 1 rise in creatinine >44μmol/L and new dialysis for any reason was 4.7% (95%CI 2.8%–6.6%), 16.7% (95%CI 13.4%–20.0%) and 14.0% (95%CI 10.9%–17.1%), respectively. In-hospital mortality and 30-day mortality was 4.9% (95%CI 2.8%–6.9%) and 6.3% (95%CI 3.7%–7.8%) in all patients versus mean EuroSCORE II 11.4% (95%CI 8.4%–14.0%, p < .01). 30-day mortality in patients undergoing surgery for aortic dissection and endocarditis was 6.2% (95%CI 0.9%–11.4%) and 6.3% (95%CI 2.7%–9.9%) versus mean EuroSCORE II 13.2% (95%CI 6.1%–21.0%, p = .11) and 14.5% (95%CI 12.1%–16.8%, p = .01), respectively.
Conclusions:
NAPaR data from Nordic countries suggest a favourable safety profile of aprotinin in adult cardiac surgery.
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