Re: Heart-surgery drug risky, researchers find


Hawki63@xxxxxxxxxxxxx wrote:
> "Sue" <chrlie699@xxxxxxxxx> wrote in message
> news:1138313939.179796.274600@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> >
> > Roman Bystrianyk wrote:
> >> Thomas H. Maugh II, "Heart-surgery drug risky, researchers find", San
> >> Jose Mercury News, January 26, 2006,
> >> Link:
> >> http://www.mercurynews.com/mld/mercurynews/living/health/13715800.htm
> >>
> >> A drug widely used during heart surgery to control bleeding doubles the
> >> risk of kidney damage, forcing an estimated 10,000 patients onto
> >> dialysis each year, according to a new study from a group that is
> >> calling for surgeons to abandon its use.
> >>
> >> Known as aprotinin, the drug also increases the risk of heart attack 48
> >> percent, heart failure 109 percent and stroke 181 percent, according to
> >> a study among nearly 4,400 patients reported today in the New England
> >> Journal of Medicine.
> >>
> >> The researchers said the drug is not even needed in most cases because
> >> there are two generic drugs that cost a tenth as much and are nearly as
> >> good at stopping bleeding without increasing risks.
> >>
> >> ``I wonder how we can ethically prescribe aprotinin when there are
> >> alternatives that are safer,'' said Dr. Dennis Mangano of the Ischemia
> >> Research and Education Foundation, who led the study.
> >>
> >> The drug, which is derived from the lung tissue of cows, was approved
> >> by the Food and Drug Administration in 1993. It is used in a
> >> significant number of the 1 million heart surgeries performed worldwide
> >> each year.
> >>
> >> An FDA official said the agency is aware of the study and is reviewing
> >> the data.
> >>
> >> Bayer, which manufactures the drug and sells it under the brand name
> >> Trasylol, said in a statement that it had not yet analyzed the study,
> >> but that the results were not consistent with its own experience.
> >
> >
> > It is my understanding that aprotinin is administered following CABG,
> > in order to reverse the anticoagulant effects of heparin. Heparin (an
> > anticoagulant) inhibits the conversion of prothrombin to thrombin, the
> > step just preceding formation of fibrin and stable platelet clot
> > formation.
> >
> > During CABG, fairly large cumulative doses of heparin are required to
> > prevent clot formation.
> >
> > Since the on-pump procedure exposes the patient's blood to a plastic
> > reservior, pump filters and much tubing, the body's clotting cascade,
> > natural immune and inflammatory repsonses are activated. All of these
> > reactions can result in red blood cell destruction and other
> > complications.
> >
> > This is one reason why minimally invasive cardiac surgery "MICS"
> > (off-pump) is generally favored over on-pump procedures,IMO (when
> > indicated).
>
>
>
> you must be referring to MIDCAB....minimally invasive direct coronary bypass
> sugery.....which is NOT always "off pump"
>
> "off pump surgery" can be sternum splitting OR minimally invasive...
>
>
> the two are not totally interchangeable
>
> in MIDCAB the surgeons does NOT split the sternum...but works thru smaller
> incisions..usually several...to sew bypass grafts onto diseased coronaries
>
> "may be performed with or without use of the heart lung machine"
>
> limitations to MIDCAB ...only can be used in a very small subset of
> patients..usually those whose disease is limited to the LAD....
>
> "beating heart" surgery..on the other hand...can be used on MOST
> patients..as long as the surgeon involved is skilled at the
> technique...approx 25% of bypass surgeries in the uS currently are off
> pump....
>
> a "stabilizer" similar to a suction cup thingie ..is applied to the
> heart..and allows the immobilization of the area being operated on...it is
> quite a fascinating surgery to watch...
>
> recovery from any heart surgery NOT involving the bypass machine is quicker
> and has less risks ..such as "pump head" and risks of emboli etc ...blood
> flow thru the heart lung machine is VERY fast..and the blood cells can be
> damaged
>
> hubby had beating heart...tradiitional sternum splitting bypass...we even
> have a videotape of the procedure...he was in recovery room ..fully awake
> several hours after his surgery began (which took a tad less than 2
> hours...3 grafts)...by 7pm night of surgery he was eating a turkey
> sandwich..home in 72 hours...
>
>
> >
> > Since the blood is not exposed to large surface areas of foreign
> > material, MISCS eliminates the need for heparin administration.
> > Therefore heparin reversal is not required, and the need for aprotonin
> > (or other similar drug) is avoided as well!
> >
> > In addition, the body's natural yet undesirable responses (such as
> > complement activation, cytokine activation, activation of coagulation
> > factors etc.) are minimzed as well.
> >
> > Just some additional thoughts.
> >
> > -Sue (non doctor)
> >

Hi Hawke,

I am sorry that I lumped all minimally invasive procedures under one
umbrella. I was really thinking about the beating heart surgery.
Years ago I supported some of the preclinical research that was used to
bring this technology to premarket approval (our device is called the
Octopus, lol).

I was also involved in some CABG (pump devices) research (studying
various coatings, like heparin-bonded for tubing, filters etc. These
coatings help to reduce potential clotting etc.

I am a little rusty in remembering the perfusion procedure now for
CABG!! I think the beating heart surgery has fantastic advantages (but
I am obviously biased)

I am so happy to that your hubby has done well following the beating
heart surgery.

Best wishes,

Sue (nondoctor)

.

Relevant Pages

  • Re: Heart-surgery drug risky, researchers find
    ... >>> A drug widely used during heart surgery to control bleeding doubles the ... >> in order to reverse the anticoagulant effects of heparin. ... > "off pump surgery" can be sternum splitting OR minimally invasive... ... > recovery from any heart surgery NOT involving the bypass machine is quicker ...
    (sci.med.cardiology)
  • Re: Heart-surgery drug risky, researchers find
    ... >> A drug widely used during heart surgery to control bleeding doubles the ... the drug also increases the risk of heart attack 48 ... > in order to reverse the anticoagulant effects of heparin. ...
    (sci.med.cardiology)
  • Heart-surgery drug risky, researchers find
    ... A drug widely used during heart surgery to control bleeding doubles the ... the drug also increases the risk of heart attack 48 ... ``I wonder how we can ethically prescribe aprotinin when there are ...
    (sci.med.cardiology)
  • Re: Heart-surgery drug risky, researchers find
    ... > A drug widely used during heart surgery to control bleeding doubles the ... in order to reverse the anticoagulant effects of heparin. ...
    (sci.med.cardiology)
  • Re: Heart-surgery drug risky, researchers find
    ... >>> It is my understanding that aprotinin is administered following CABG, ... >>> in order to reverse the anticoagulant effects of heparin. ... I was really thinking about the beating heart surgery. ...
    (sci.med.cardiology)
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