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

Abstract

<p>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. <br></p><p>Design. Data come from 10 cardiac surgery centres in Finland, Norway and Sweden participating in the European Nordic aprotinin patient registry (NAPaR). <br></p><p>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. <br></p><p>Conclusions. NAPaR data from Nordic countries suggest a favourable safety profile of aprotinin in adult cardiac surgery.</p>