This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Wajon, P. Articles by Thrift, B. Search for Related Content PubMed PubMed Citation Articles by Wajon, P. Articles by Thrift, B. Related Collections Blood Heart

---

CARDIOVASCULAR ANESTHESIA

Intraoperative Plateletpheresis and Autologous Platelet Gel Do Not Reduce Chest Tube Drainage or Allogeneic Blood Transfusion After Reoperative Coronary Artery Bypass Graft

Departments of Anaesthetics and Cardiothoracic Surgery, Royal Prince Alfred Hospital, Camperdown NSW, Australia

Address correspondence to Dr. Paul Wajon, MB, BS, FFARACS, FANZCA, P.O. Box 70, Gladesville NSW, Australia 1675. Address e-mail to pwajon{at}ozemail.com.au No reprints will be available from the author.

Platelet-rich plasma (PRP) is postulated to decrease postoperative mediastinal chest tube drainage (MCTD) and allogeneic blood transfusions (ABT) after surgery with cardiopulmonary bypass. However, recent metaanalysis of the literature reveals that few good quality (therapeutic yield) trials that show a benefit have been published. The potential hemodynamic instability caused by plateletpheresis has not been emphasized. We studied the effect of plateletpheresis on MCTD, ABT, and hemodynamic stability in reoperative coronary artery bypass graft patients, a group perceived to be at high risk for ABT. Ninety patients were randomly assigned to Pheresis or Control groups. -Aminocaproic acid was given to all patients. Hemodynamic instability was assessed by degree of volume and inotrope resuscitation required. Part of the sequestered platelet volume was used to make autologous platelet gel, which was applied as a wound sealant. Mean pheresis yield was 30% ± 7% of the circulating platelet mass or 6.4 ± 2.2 allogeneic platelet unit equivalents. Total MCTD did not differ between the groups. There were no differences in mean packed red blood cell, platelet, and plasma transfusion rates. Overall, 52% of the Pheresis group received ABT, versus 55% of the Control group. Fifty-three percent of the Pheresis group patients exhibited significant hemodynamic instability, versus 27% of the Control group (P < 0.05). This study was unable to show any reduction in MCTD or ABT, although the plateletpheresis technique may offset platelet dysfunction caused by aspirin or increased blood exposure to nonbiologic surfaces, or it may compensate for lack of antifibrinolytic use. The significantly increased incidence of hemodynamic instability in the Pheresis group means that the risk/benefit ratio must be determined for individual cardiac surgical units.

IMPLICATIONS: This trial of plateletpheresis in reoperative coronary artery surgery was performed to assess its effect on allogeneic blood product transfusion. Routine antifibrinolytic usage, minimal aspirin, and nonbiologic surface exposure seem to negate any benefit of the technique in these patients. These findings differ from those of other recent reports. The study also emphasizes the potential hemodynamic disturbances related to the pheresis process.

This article has been cited by other articles:

				J Whitlow, A. Shackelford, A. Sievert, and J. Sistino Barriers to the acceptance and use of autologous platelet gel Perfusion, September 1, 2008; 23(5): 283 - 289. [Abstract] [PDF]

				T. McGrath, C. G. Koch, M. Xu, L. Li, T. Mihaljevic, P. Figueroa, and E. H. Blackstone Platelet Transfusion in Cardiac Surgery Does Not Confer Increased Risk for Adverse Morbid Outcomes Ann. Thorac. Surg., August 1, 2008; 86(2): 543 - 553. [Abstract] [Full Text] [PDF]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				M. S. Avidan, E. L. Alcock, J. Da Fonseca, J. Ponte, J. B. Desai, G. J. Despotis, and B. J. Hunt Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery Br. J. Anaesth., February 1, 2004; 92(2): 178 - 186. [Abstract] [Full Text] [PDF]

				P. R. Belcher, E. W. Muriithi, P. Wajon, and J. Gibson Postoperative Bleeding After Coronary Artery Bypass Surgery with Cardiopulmonary Bypass * Response Anesth. Analg., November 1, 2002; 95(5): 1466 - 1467. [Full Text] [PDF]