Application Of Modified Autologous Plateletpheresis In Cardiac Surgery

Objective:The purpose of this study was to evaluate the feasibility,safety and effectiveness of modified autologous plateletphresis in patients undergoing cardiac surgery.Methods:40 consecutive patients in our hospital undergoing elective cardiac valve surgery were enrolled in this trial.The patients were prospectively randomized into two groups:the trail group(APP group,n=20)and the control group(C group,n=20).The trail group:After heparinization and institution of CPB,blood was diverted from the venous portion of the circuit.PRP was seperated from heparinized blood by plateletpheresis program of Cell Saver.PRP was given after protamine infusion.Intraoperative Cell Saver was used to salvage red blood cells in every patients.C group:No autologous platelet rich plasma was sequestered.Intraoperative Cell Saver was used to salvage red blood cells in every patients.The procedures and results of modified autologous plateletpheresis in the APP group were analyzed.Hemoglobin concentration,Pit,coagulation function,platelet aggregation rate and rapid thrombelastogram were measured at T1(5 minutes following anesthesia induction),T2(5 minutes following completion of protamine administration),T3(return to the ICU)and T4(24 hours after return to the ICU).In all patients,mediastinal tube drainage was measured at 1,24 and 48 hours postoperatively.Homologous blood product transfusion,the duration of mechanical ventilation,the length of postoperative intensive care unit stay and hospital stay were analyzed.Results:(1)There were no significant differences in base line data between two groups.In T1,there was no significant difference in Hb concentration,Plt,PT,PTA,INR,platelet aggregation rate and Rapid thrombolytic diagram between two groups.(2)In the APP group,the volume of heparinized blood was 1621.25±114.16ml,the volume of PRP was 236.9±44.35ml,the Plt in the PRP was(685.3±46.8)×109/L.(3)In T3,the Plt in the APP group was significantly higher than the control group(P=0.029).In T3,the MA of Rapid thrombolytic diagram in the APP group was significantly.higher than the control group(P=0.003).In T4,the Plt in the APP group was significantly higher than the control group(P=0.044).(4)In the APP group,modified autologous plateletphres is practicable and safe.There was no intraoperative and postoperative complication in the APP group.In the control group,1 patients got postoperative pulmonary infection and prolonged the intubation time,and the rest of patients recovered well postoperatively.No postoperative death occurred in both groups.There was no significant difference in mediastinal tube drainage,homologous blood product transfusion,the duration of mechanical ventilation,the length of postoperative intensive care unit stay and hospital stay between the two groups.Conclusion:Modified autologous plateletphres is practicable and safe in patients undergoing cardiac surgery.Modified autologous plateletphresis can effectively protect platelets in CPB cardiac surgery.