PLATELETPHERESIS BEFORE REDO CABG DIMINISHES EXCESSIVE BLOOD-TRANSFUSION

Background. Blood conservation remains an important element for patien ts undergoing cardiac operations with cardiopulmonary bypass. Preopera tive platelet-rich plasma (PRP) harvest is an autologous blood conserv ation method. The efficacy of preoperative PRP harvest and post-cardio pulmonary bypass reinfusion on postoperative bleeding and need for pos toperative blood transfusion was evaluated in patients undergoing redo coronary artery bypass grafting in a prospective, randomized manner. Methods. All adult patients admitted for redo coronary artery bypass g rafting entered into the study. The PRP harvest aim was 20% or more of the total estimated circulating platelets. Immediately preoperatively three sequestration cycles were performed. The PRP was reinfused afte r weaning from cardiopulmonary bypass. One hundred seven parameters/pa tient were recorded. There were 20 patients in the PRP group and 20 co ntrols (without PRP harvest). Results. Patient characteristics, operat ive data, and preoperative hematologic parameters did not differ betwe en the groups. In the PRP group, the mean platelet count in the PRP wa s 864 +/- 139 x 10(3)/mu L, and the platelet yield was 27% +/- 5% (ran ge, 20% to 37%). The average total chest tube blood loss was 423 mL (P RP) compared with 1,462 mL (controls; p < 0.001). Fourteen patients in the control group required blood transfusions postoperatively compare d with only 1 patient in the PRP group (p < 0.001). Postoperative flui d requirements were also significantly greater in the control group (p < 0.001). Postextubation gas exchange was significantly better in the PRP group compared with controls (p < 0.01). Postoperative ventilatio n time and intensive care stay were significantly shorter in patients in the PRP group. Conclusions. A preoperative PRP harvest of 20% or mo re of the total platelets and reinfusion of the PRP after cardiopulmon ary bypass resulted in significantly less postoperative blood loss and decreased fluid and blood transfusion requirements compared with cont rols. Postextubation gas exchange, ventilation time, and time required in the intensive care unit were also better, and the method was found cost-effective.