Platelet Function During Platelet-rich Plasma Sequestration in Complex Cardiac Surgical Procedures – Prospective Controlled Study

Roman Hajek, Ondrej Zuscich, Ivo Fluger, Petr Caletka, Vladimir Lonsky, Petr Santavy, Ludek Slavik, Jana Ulehlova

University Hospital Olomouc, Olomouc, Czechia

Date, time and location: 2018.05.26 15:30, Press Hall, 2F

Abstract

Objectives:

Contemporary cell-salvage technology can preserve platelets in platelet-rich plasma (PRP) sequestration We tested the presevation of platelet functions during and after PRP sequestration.

Methods:

Written informed consent, local ethic commitee approval.

Elective surgery CPB>2 hours. Initial hematocrit >0,35 (800 ml of whole blood processed) RBC+PRP sequestration simultaneously, PRP retransfused after theCPB.

CPB: X- coating, roller pump, UFH:ACT>400s, TXA 30mg/kg.

Cell saver: CPD-A bags, EDTA vacutainer, manufacturer protocol.

Platelet count- flow cytometry. Optical aggregometry: collagen, ADP, ristocetin and epinephrin induced aggregation.Whole blood sample before surgery, from processed PRP,after retransfusion, after surgery.Tromboelastography before/after surgery.

Results:

Sequestration group: 21 patients (94% male), control 12 patients (80%M). Both group comparable by age (67 both), EuroSCORE (3,37 vs 3,62%), aortic(61 vs 49%), redo surgery(22 vs 14%). Antiplatelet medication withdrawn. No difference in perioperative (605 vs 564ml) postoperative (711 vs 652 ml)blood loss, transfusion of RBC (1,6 vs 2,4 TU), FFP (1,7 vs 1,7 TU), PLT (1 vs 0 TU ), fibrinogen, PCC,additional TXA (18 vs 14%), reexploration because of bleeding (16 vs 14%), ICULOS (4 vs 3,5 days), HLOS (11,5 vs 10,5 days), 30day mortality (1 vs 0). Platelet count decreased(185 to 136 vs 230 to 136). Platelet count after CPB was lower in PRP (105 vs 196 p=0,001) but not at the end (136 both). Significant decrease of collagen, ADP and epinephrin mediated aggregation but preserved values of ristocetin mediated aggregation recorded.

Conclusion:

The using og PRP sequetrastion have no impact on bleeding, transfusion therapy and clinical outcome in complex cardiac surgery. It preserves platelet count and ristocetin, but no other receptor mediated platelet aggregation.

supported by institutional grantFN Olomouc 87-72.

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