John Parker Gott, MD, William A Cooper, MD, Frank E Schmidt, MD, W

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Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies John Parker Gott, MD, William A Cooper, MD, Frank E Schmidt, MD, W.Morris Brown, MD, Carolyn E Wright, MS, John D Merlino, MD, James D Fortenberry, MD, W.Scott Clark, PhD, Robert A Guyton, MD The Annals of Thoracic Surgery Volume 66, Issue 3, Pages 747-753 (September 1998) DOI: 10.1016/S0003-4975(98)00695-X

Fig 1 Each bar represents one of the 400 patients. This projection illustrates the dispersion of outliers and the interaction between percent predicted operative mortality, treatment, and hospital charges. Note the overall positive correlation between predicted risk and hospital charges is blunted for the aprotinin patients. (A = aprotinin; H = heparin-bonded circuitry; L = leukocyte depletion; S = standard.) The Annals of Thoracic Surgery 1998 66, 747-753DOI: (10.1016/S0003-4975(98)00695-X)

Fig 2 Chest tube drainage was significantly lower for the aprotinin group at all times (∗p = 0.0003; ∗∗p = 0.0006; ∗∗∗p = 0.0024). (A = aprotinin; H = heparin-bonded circuitry; L = leukocyte depletion; S = standard.) The Annals of Thoracic Surgery 1998 66, 747-753DOI: (10.1016/S0003-4975(98)00695-X)

Fig 3 Markers of inflammation after extracorporeal circulation. (A) Complement activation by extracorporeal circulation was significantly blunted by heparin-bonded circuitry (∗p = 0.00001). (B) The leukocyte depletion strategy prevented the leukocytosis usually seen after cardiopulmonary bypass (CPB). This effect persisted into the first postoperative day (POD) (∗p ≤ 0.004). (C) The antifibrinolytic effect of aprotinin was evidenced by significantly lower d-dimer levels after extracorporeal circulation (∗p = 0.01). (A = aprotinin; H = heparin-bonded circuitry; L = leukocyte depletion; S = standard.) The Annals of Thoracic Surgery 1998 66, 747-753DOI: (10.1016/S0003-4975(98)00695-X)

Fig 4 Translation into clinical outcomes: effect of treatments on length of stay and hospital charges. (A) Leukocyte depletion led on average to a 1-day reduction in length of stay for the low-risk patient who represented about 70% of the study. Aprotinin reduced mean hospital stay up to 10 days for high-risk patients. There was no treatment effect evident for the medium-risk group (∗p = 0.02). (B) Substantial comparative savings of $2,000 to $6,000 in mean charges were realized for the low-risk stratum using leukocyte depletion. The high-risk patient had a highly significant economic benefit with a mean savings in hospital charges of $6,000 to $48,000 when treated with aprotinin (∗p = 0.05, ∗∗p = 0.0007). (A = aprotinin; H = heparin-bonded circuitry; I = low-risk stratum, <5% predicted mortality; II = medium-risk stratum, 5% to 15% predicted mortality; III = high-risk stratum, predicted mortality >15%; L = leukocyte depletion; S = standard.) The Annals of Thoracic Surgery 1998 66, 747-753DOI: (10.1016/S0003-4975(98)00695-X)