INTRAOPERATIVE PLASMAPHERESIS IN CARDIAC-SURGERY

Objective: To determine the effects of intraoperative plasmapheresis o n total transfusion requirements, mediastinal drainage, and coagulatio n. Design: The trial was prospective, randomized, and controlled. Sett ing: Inpatient cardiac surgery at a university medical center. Partici pants: Two hundred ninety-three consecutive patients undergoing cardia c surgery requiring cardiopulmonary bypass. Interventions: Intraoperat ive plasmapheresis (IP) was performed in 147 patients before hepariniz ation; platelet-rich plasma was reinfused immediately after heparin re versal. Measurements and Main Results: Mediastinal chest tube drainage during the first 12 postoperative hours was significantly less in the IP group (p = 0.022), but no difference was noted in total postoperat ive blood loss between the two groups. The amount of packed red cells and fresh frozen plasma transfused to the IP group in the intensive ca re unit was significantly lower (p = 0.02, p = 0.002, respectively); 5 1.4% of patients required no transfusion compared with the control gro up (34.5%) (p = 0.006). No differences were noted for data collected i n the intensive care unit in terms of the mean duration of chest tube drainage, ventilator time, or any hematologic variables at baseline or at any subsequent time in the study. Conclusions: After cardiac surge ry, intraoperative plasma-pheresis reduces early postoperative bleedin g and decreases the need for homologous transfusions. Copyright (C) 19 97 by W.B. Saunders Company.