Department of Anesthesiology, University of Texas Medical School at Houston, Memorial Hermann Heart and Vascular Institute, Houston, TX 77030, USA.
Ann Thorac Surg. 2013 May;95(5):1525-30. doi: 10.1016/j.athoracsur.2012.09.054. Epub 2012 Dec 13.
Coagulopathy is a common complication after ascending and transverse arch aortic surgery with profound hypothermic circuit arrest (PHCA). Blood conservation strategies to reduce transfusion have been ongoing and involve multiple treatment modalities in modern cardiac surgery. The purpose of this study is to evaluate the effectiveness of autologous platelet-rich plasma (aPRP) as a blood conservation technique to reduce blood transfusion in ascending and arch aortic surgery.
Between 2003 and 2009, we retrospectively reviewed 685 cases of ascending aorta and transverse arch repair using PHCA. A total of 287 patients in which aPRP was used (aPRP group) were compared with 398 patients who did have aPRP (non-aPRP group). Perioperative transfusion requirements and clinical outcomes that included early mortality, postoperative stroke, renal dysfunction, prolonged ventilation, coagulopathy, and length of postoperative intensive care unit stay were analyzed. The data were analyzed by mean and frequency for continuous variables and qualitative variables. To account for potential selection bias, 2 types of propensity analysis were performed.
In both unadjusted and adjusted analysis, perioperative transfusions were fewer in the aPRP group compared with the non-aPRP group: (3.9 units fewer packed red blood cells, 4.5 units fewer fresh frozen plasma, 7.9 units fewer platelets, and 6.8 units fewer cryoprecipitate). In all analyses, postoperative morbidity (stroke, duration of mechanical ventilation, and intensive care unit stay) were significantly improved. Hospital mortality rate was not significantly decreased.
The utilization of aPRP was associated with a reduction in allogeneic blood transfusions as well as a decrease in early postoperative morbidity during repairs of the ascending and transverse arch aorta using PHCA.
凝血功能障碍是升主动脉和弓部主动脉手术中使用深低温体外循环（PHCA）后常见的并发症。为了减少输血，一直在采用血液保护策略，这些策略涉及到现代心脏手术中的多种治疗方式。本研究的目的是评估自体富血小板血浆（aPRP）作为一种减少升主动脉和弓部主动脉手术中输血的血液保护技术的有效性。
在 2003 年至 2009 年期间，我们回顾性分析了 685 例使用 PHCA 的升主动脉和弓部修复手术。将使用 aPRP 的 287 例患者（aPRP 组）与未使用 aPRP 的 398 例患者（非 aPRP 组）进行比较。分析了围手术期输血需求和临床结果，包括早期死亡率、术后卒中、肾功能障碍、延长通气、凝血功能障碍和术后重症监护病房住院时间。连续变量和定性变量采用均值和频率进行分析。为了考虑潜在的选择偏倚，我们进行了两种倾向评分分析。
在未调整和调整分析中，aPRP 组的围手术期输血量均少于非 aPRP 组：（少输 3.9 单位浓缩红细胞、4.5 单位新鲜冷冻血浆、7.9 单位血小板和 6.8 单位冷沉淀）。在所有分析中，术后发病率（卒中、机械通气时间和重症监护病房住院时间）均显著改善。住院死亡率无显著降低。
在使用 PHCA 修复升主动脉和弓部主动脉时，使用 aPRP 与减少异体输血以及降低早期术后发病率相关。
