title: Autologous platelet-rich plasma reduces transfusions during ascending aortic arch repair: a prospective, randomized, controlled trial.
abstract: BACKGROUND
  Blood conservation using autologous platelet-rich plasma (aPRP), a technique of whole blood harvest that separates red blood cells from plasma and platelets before cardiopulmonary bypass with retransfusion of the preserved platelets after completion of cardiopulmonary bypass, has not been studied extensively. We sought to prospectively determine whether aPRP reduces blood transfusions during ascending and transverse aortic arch repair.
  
  
  METHODS
  We randomly assigned 80 patients undergoing elective ascending and transverse aortic arch repair using deep hypothermic circulatory arrest to receive either aPRP (n = 38) or no aPRP (n = 42). Volume of aPRP retransfused was 726 ± 124 mL. The primary end point was transfusion amount. Secondary end points were death, stroke, renal failure, pulmonary failure, and transfusion costs. Perioperative transfusion rate was defined as blood transfusions given during surgery and up to 72 hours afterward. The surgeon and intensivist were blinded to the treatment arm. Because an anesthesiologist initiated the protocol, the surgeon was not aware of aPRP collection, as this occurred only after the sterile drape was in place. In addition, because cell salvage was performed on all cases, differentiation in perfusionist activities (during spinning of aPRP) was not evident. Platelet, fresh frozen plasma, and cryoprecipitate intraoperative transfusions were performed only after heparin was reversed and the patient was judged as coagulopathic on the basis of associated criteria: cryoprecipitate transfusion for fibrinogen level less than 150 μg/dL, platelet transfusion for platelet count less than 80,000, and fresh frozen plasma when thromboelastogram test was suggestive or a partial thromboplastin time was greater than 55 seconds, and prothrombin time was greater than 1.6 seconds.
  
  
  RESULTS
  Early mortality, stroke, and respiratory complications were similar between groups. Only acute renal failure was reduced in the aPRP group, 7% versus 0% (p < 0.014). Mean transfusion rate of packed red blood cells was reduced by 34%, fresh frozen plasma by 52.8%, cryoprecipitate by 70%, and platelets by 56.7% in the aPRP group (p < 0.02). Hospital length of stay (9.4 ± 5.3 days versus 12.7 ± 6.3 days; p < 0.014) and transfusion costs ($1,396 ± $1,755 versus $2,762 ± $2,267; p < 0.004) were reduced in the aPRP group.
  
  
  CONCLUSIONS
  The use of aPRP reduced allogeneic transfusions during ascending and transverse aortic arch repair with deep hypothermic circulatory arrest. This translated to less acute renal failure, decreased length of stay, and lower transfusion costs. Further studies examining the coagulation factors of aPRP are required.
authors: Department of Anesthesia, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Shao Feng
authors: SF
authors: Zhou
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas. Electronic address: anthony.l.estrera@uth.tmc.edu.
authors: Anthony L
authors: AL
authors: Estrera
authors: Department of Anesthesia, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Paul
authors: P
authors: Loubser
authors: Department of Anesthesia, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Craig
authors: C
authors: Ignacio
authors: Department of Anesthesia, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Sreelatha
authors: S
authors: Panthayi
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Charles
authors: C
authors: Miller
authors: Department of Anesthesia, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Roy
authors: R
authors: Sheinbaum
authors: Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Heart & Vascular Institute, Houston, Texas.
authors: Hazim J
authors: HJ
authors: Safi
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001804:Blood Transfusion, Autologous / Q000379:methods / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D053657:Platelet-Rich Plasma; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012016:Reference Values; D016037:Single-Blind Method; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality