Aprotinin in paediatric cardiac surgery

are no published reports of the use of aprotinin in current paediatric cardiac surgical practice, yet there are a number of special features about this type of surgery which might indicate a particular usefulness for an agent such as aprotinin. A larger number of neonatal surgical procedures are being performed, particularly the arterial switch procedure for simple transposition of the great vessels (TGA). In neonates one may note that the tissues are more friable, and that surgery frequently involves long suture lines which become inaccessible upon completion of the repair. Neonates may also have incompletely developed clotting mechanisms and tolerate haemorrhage badly, particularly minor degrees of tamponade. Local tamponade with direct compression of a coronary artery or a great vessel is also a significant problem in children. The complexity of the procedures being performed is greater (for example the Norwood procedure, or the massive pulmonary artery reconstructions associated with delayed repair of Fallot’s tetralogy or complex pulmonary atresia) and there is an increasing incidence of redo surgery, especially for replacement of conduits which are used in several reconstructive procedures in paediatric cardiac surgery, e.g. pulmonary atresia, truncus arteriosus and Rastelli procedure. These conduit replacements can be extremely difficult and are known to be associated with a