Effect Of Autologous Plateletpheresis And Back-transfusion On Blood Conservation And Short Term Prognosis In Patients Undergoing Redo Cardiac Valve Replacement Surgery

Objective To evaluate the effect of autogolous plateletpheresis and back-transfusion on blood conservation and short time prognosis in patients undergoing redo cardiac valve replacement surgery with CPB.Methods Thirty four patients,aged 28~67 yr,of NYHA Ⅱ or Ⅲ,scheduled for elective redo cardiac valve replacement operation with CPB were randomly assigned to two equal groups of 15 each(n=15 each): control group,only autologous blood transfusion was performed;experimental group,acute plateletpheresis and back-transfusion and autologous blood transfusion was performed,other blood conservation measures were the same in the two groups.The whole course of autogolous plateletpheresis was completed after general anesthesia induction and completed before heparinization,the platelet rich plasma harvest was transfused to the patient after the completion of CPB and protamine neutralization of heparin in the experi-mental group.Hb,Plt,PT,APTT,Fib and maximum amplitude(MA)in thrombe-lastography analysis were measured before induction,after plateletpheresis or before heparinization,immediately after cardioulmonary bypass and at 1,24 and 48 h after operation.CPB time,aortic crossclamping time,the chest tube drainage at 1 and 24 h,the requirement of homologous blood and blood products,the time of using mechanical ventilator supporting,ICU stay and hospitalization were recorded.Platelet rich plasma harvest and the whole blood donation for plateletpheresis,the platelet count were recorded after plateletpheresis.Extract 2ml from platelet rich plasma before back-transfusion for the preparation of electron microscope specimens,morphology and ultrastructure were observed compared with apheresis platelets.Results In experimental group average platelet rich plasma harvest was(187±27)ml and the mean whole blood donation was(1205±168)ml.The platelet count of the sequestered plasma was(1100±235)×109/L,accounting for(28±3)% of the total number of platelet in whole blood volume.The platele-tpheresis took(35±10)min.Compared with control group,the platelet count and MA at 1h,24 h and 48 h after operation was significantly higher and the volume of chest tube drainage at 1h and 24 h postoperatively,homologous blood and blood products usage,the time of using mechanical ventilator supporting and ICU stay were significantly reduced in the experimental group(P<0.05).Other variables did not differ between the two groups(P>0.05).The morphology and ultrastructure of the sequestered platelet were not different compared to those of apheresis platelets.Conclusion Acute autologous plateletpheresis and back-transfusion comb-ined with autologous blood transfusion in patients undergoing redo cardiac valve replacement surgery with CPB was an effective method for blood conservation and the improvement of short term prognosis.