Blood Conservation Effect Of Different Red Blood Cell Transfusion Thresholds And Autologous Platelet-rich Plasma For Patients Undergoing Total Aortic Arch Repair

Comparison of the Blood Conversation Effect of Two Different Red Blood Cell Transfusion Thresholds for Patients undergoing Total Aortic Arch Surgery with Deep Hypothermic Circulatory ArrestObjective:Patients undergoing total aortic arch surgery with deep hypothermic circulatory arrest(DHCA)are usually involved with massive bleeding and high incidence of allogeneic blood transfusion,and their red blood cell(RBC)transfusion threshold is unclear and controversial.The purpose of this retrospective study was to explore whether a restrictive RBC transfusion threshold was as effective as a liberal RBC transfusion threshold for patients undergoing total aortic arch surgery with DHCA.Methods:A total of 74 patients undergoing total aortic arch surgery with DHCA in our center from January 1,2014 to December 31,2014 were divided into two groups according to the RBC transfusion threshold they used,the restrictive group(n=40)received allogeneic RBC transfusion if the hemoglobin(Hb)level of the patient fell below 8 g/dL during the surgery,and in liberal group(n=34)the Hb threshold for allogeneic transfusion was 10 g/dL.Data on patient demographics,procedure characteristics,perioperative allogeneic blood use and post-operational morbidity and mortality were collected and analyzed.Results:The two groups demonstrated similar preoperative demographics and comorbidities.In total,the restrictive group required fewer total perioperative transfusion of RBCs((3.9±4.8)vs(8.5±6.9)units,p=0.001)and platelets((1.9±0.8)vs(2.6±1.0)units,p=0.003),compared with the liberal group.While postoperative mortality and complications including 30-day mortality,bleeding requiring reexploration,chest tube drainage did not differ significantly between two groups.Conclusions:For patients undergoing total aortic arch surgery with DHCA,a restrictive RBC transfusion threshold(Hb<8 g/dL)may be as effective as a liberal RBC transfusion threshold(Hb<10 g/dL)during the surgery,with similar short-term clinical outcomes and less allogeneic transfusion.Blood Conversation Effect of Autologous Platelet-rich Plasma in Total Aortic Arch Surgery with Deep Hypothermic Circulatory Arrest:a Prospective Randomized Controlled StudyBackground:The blood conservation effect of intraoperative plateletpheresis and autologous platelet-rich plasma(APRP)retransfusion is still controversial for cardiovascular surgery patients.Patients undergoing total aortic arch surgery with deep hypothermic circulatory arrest(DHCA)are frequently complicated with coagulopathy,massive bleeding and allogeneic transfusion.This prospective study aimd to evaluate the blood conservation effect of APRP in patients undergoing total aortic arch surgery with DHCA.Methods:Consecutive adult patients(1870 years old)from May 14,2015 to June 27,2016 undergoing total aortic arch repair using DHCA were enrolled.Inculsion criteria were:preoperative platelet count>150×109/L,hematocrit(Hct)>33%,antiplatelet medications had been ceased for more than 5 days.Participants were randomly assigned to receive either APRP(APRP group)or no APRP(Control group).APRP group received APRP harvest technique after anesthesia induction and before administration of heparin.The target amount of whole blood collected and processed was 15～20 ml/kg.The harvested APRP was retransfused to the patient after heparin neutralization with protamine,the separated red blood cell(RBC)was retransfused to the patient whenever necessary(hypovolemia or Hb of the patient reached RBC transfusion threshold).The primary outcome was incidence of intraoperative fresh frozen plasma(FFP)transfusion.Secondary outcome included incidence of intraoperative allogeneic platelet transfusion,amount of intraoperative FFP and platelet transfusion,perioperative allogeneic RBC transfusion,thromboelastogram(TEG)changes after APRP retransfuison and 24 hours after surgery,postoperative morbidity and in-hospital mortality.Results:Eighty patients were enrolled and randomized,39 in APRP group and 41 in control group.The mean amount of whole blood collected for plateletpheresis was 1284±200ml,the mean amount of APRP harvested was 799±131ml,the mean platelet count of harvested APRP was(188±71)×109/L.Incidence of intraoperative FFP transfusion did not differ significantly between two groups.Compared with control group,the TEG R value and K value were shorter and a was larger in APRP group after APRP retransfusion.Fewer amount of intraoperative platelet transfusion was observed in APRP group(1(1,2)vs 2(1,2)units,p=0.046).Incidence of intraoperative platelet transfusion,amount of intraoperative FFP transfuison,perioperative RBC transfusion were similar between two groups.APRP group has longer postoperative Intensive Care Unit(ICU)length of stay(4(2,6)vs 2(1,4.5)days,p=0.013).Other postoperative morbidity and in-hospital mortality did not differ significantly between two groups.Conclusions:For patients undergoing total aortic arch surgery with DHCA,intraoperative plateletpheresis and APRP retransfusion improved coagulation function of the patient,reduced amount of intraoperative platelet transfusion;and did not reduce incidence of intraoperative FFP or platelet ransfusion,amount of intraoperative FFP transfusion,or perioperative RBC transfusion.