AUTOLOGOUS PLATELET-RICH PLASMAPHERESIS - RISK VERSUS BENEFIT IN REPEAT CARDIAC OPERATIONS

Preoperative platelet-rich plasmapheresis has been suggested as a mean s of reducing homologous blood transfusions in cardiac surgical patien ts. The current study evaluated this technique in patients undergoing repeat cardiac operations. Fifty-two patients undergoing repeat myocar dial revascularization and/or valve replacement were evaluated in a pr ospective randomized controlled study design. Autologous platelet-rich plasma (PRP) was harvested after the induction of anesthesia in the e xperimental group. After reversal of heparin, each patient received hi s or her autologous plasma. Patients in the control group did not have plasmapheresis and received standard transfusion therapy if coagulati on variables were abnormal and a coagulopathy was clinically evident. Routine coagulation tests, thromboelastography (TEG), perioperative bl eeding, and transfusion requirements were compared in the two groups. Forty-four patients completed the study. A significantly larger volume of packed red blood cells (PRBCs) was transfused in the PRP group tha n in the control group (P = 0.03). Platelet and fresh frozen plasma (F FP) transfusions did not differ between the two groups. Mediastinal tu be drainage did not differ between the two groups. During PRP infusion , 60% of the patients required treatment for moderate hypotension (mea n arterial pressure [MAP] < 60 mm Hg). Only 16% of control patients re quired treatment for hypotension during the comparable time period (P < 0.05). No patient who completed the study returned to the operating room for postoperative bleeding. These data suggest that PRP did not r educe postbypass bleeding or transfusion requirements in repeat cardia c surgical patients. Moreover, the incidence of hypotension during PRP reinfusion introduces a potential risk to the procedure in the absenc e of any obvious benefit.