Reduced use of allogeneic platelets through high-yield perioperative autologous plateletpheresis and reinfusion

Effects of Autologous Platelet Rich Plasma on Intraoperative Transfusion and Short-Term Outcomes in Total Arch Replacement (Sun's Procedure): A Prospective, Randomized Trial

OBJECTIVE

To observe the effect of collecting and retransfusing autologous platelet rich plasma (aPRP) on the amount of allogeneic blood usage in total arch replacement (Sun's surgery) and the outcomes 30 days after surgery.

DESIGN

A prospective, randomized trial.

SETTING

A tertiary university hospital specialized in cardiovascular diseases.

PARTICIPANTS

The study comprised 120 patients undergoing Sun's surgery for Stanford type A acute aortic dissection.

INTERVENTIONS

aPRP was harvested before incision and was re-transfused after heparin neutralization for patients in the treatment group.

MEASUREMENTS AND MAIN RESULTS

There was no significant difference in preoperative demographic data between the 2 study groups. Intraoperative transfusions of erythrocyte (p = 0.009), plasma (p = 0.017), cryoprecipitate (p = 0.002), and platelets (p < 0.001) in the treatment group were reduced significantly. In addition, less blood loss was observed in the treatment group (p = 0.002). The durations of postoperative mechanical ventilation (p = 0.029) and hospitalization (p = 0.002) of the treatment group were significantly shorter. There were no statistically significant differences in the length of intensive care unit stay, the incidence of complications, and mortality 30 days after surgery.

CONCLUSION

In total arch replacement (Sun's surgery), collecting and retransfusing aPRP reduced intraoperative transfusions of erythrocyte, plasma, and cryoprecipitate and decreased the duration of postoperative mechanical ventilation and hospitalization. This technique had no significant effect on the incidence of complications and mortality 30 days postoperatively.