The Effect Of Aprotinin On Renal Function In Direct-vision Cardiac Surgery

Objective Aprotinin is a serine protease inhibitor undergoing metabolism in the kidney, its elimination is almost entirely carried out by the kidney. Studing the effect of aprotinin on renal in direct-vision cardiac surgery is valuable.Methods In a randomized prospective study ,30 patients were divided in three groups: control group(n=10), low-dose aprotinin group(n=10),high-dose aprotinin group(n=10).serum and urine samples were taken at the following times:(1) l day preoperatively.(2) on the first hour postoperativly .(3) the first day postoperatively. (4)the third day postoperatively . (5) the fifth day postoperatively. Renal function was assessed for 5 postoperative days using creatinine , urea nitrogen, β2-microglobulin and sodium dodecyl sulfate electrophoresis (SDS-PAGE). In addition ,the urine prodution and chest tube drainage were observed.Results Temporary renal dysfunction was found in all patients after the operation. Urine β2-microglobulin level and the bands of proteins filtrated in the renal tubular system were siginfigcantly increased in the high-dose aprotinin group for 5 days in comparison with the control group(P<0.05),with amaximum on the first day postoperatively.The difference in the postoperative change in urineβ2-microglobulin level and the bands of proteins filtrated in the renal tubular system was not statistically significant for the high-dose aprotinin and the control group as compared with the low-dose aprotinin group. No relevant changes in serum creatinine,urine prodution,blood β2-microglobulin levels could be observed among three groups. Two aprotinin group significantly reduces postoperative bleeding.Conclusions extracorporeal circulation could impair renal function .aprotinin impairs renal function in addition by overloading the tubular reabsorption mechanisms. It is safe for patients with normal renal function preoperatively to use different doses of aprotinin during open heart operation under mild-moderate hypothermia. Aprotinin can reduce bleeding in patients undergoing direct-vision cardiac operations.