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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio F Corno Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Corno, A. F Search for Related Content PubMed Articles by Corno, A. F

Invited Commentary

Department of Cardiovascular Surgery, University Hospital of Vaud, Rue de Bugnon 46, Lausanne CH-1011, Switzerland

The authors report their experience with two different modes of administration/dosage of aprotinin in 50 children undergoing cardiopulmonary bypass for repair of tetralogy of Fallot. There are several positive points to comment on in this well-designed prospective randomized clinical study, with an extensive list of data collected and analyzed, and random allocation of the patients to one of the two groups.

First, the background to the utilization of aprotinin has been adequately reported by the authors in both the scientific and clinical aspects. Second, the treatment of all patients strictly followed the preoperatively determined rules, particularly with regard to the decision of utilizing blood or blood products during or after the operation. This goal is difficult to achieve, particularly in a pro-spective study with pediatric patients. Furthermore, the authors were able to demonstrate the advantages of aprotinin by comparison with a control group not receiving aprotinin, even if we do not know if the control group is a historical group of matched patients or another prospective study with blinded random allocation. All the arguments in favor of increased coagulation disturbances in cyanotic children are well put in this manuscript, but the clinical comparison with a matched group of non-cyanotic children could provide clear evidence of the clinical consequences of cyanosis versus non-cyanosis on the effects of aprotinin.

Lastly, the authors reported the current knowledge of the antiinflammatory properties of aprotinin, but they did not provide any information regarding the evaluation of this property in their experience, since they did not report any clinical parameter reflecting the inflammatory response. Furthermore, they did not use "controlled reoxygenation" at the beginning of cardiopulmonary bypass, known to be a potential method of reducing the negative effects of uncontrolled acute reoxygenation after a period of chronic hypoxia. This paper will definitely stimulate all readers who are involved in the care of pediatric patients under-going cardiopulmonary bypass for repair of cyanotic congenital heart defects to further extend the current knowledge on control of postoperative coagulation disorders.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio F Corno Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Corno, A. F Search for Related Content PubMed Articles by Corno, A. F