Effect of preoperative autologous platelet-rich plasmapheresis on postoperative bleeding in patients undergoing heart valve surgery.

IF 2.1 3区医学 Q3 RESPIRATORY SYSTEM Journal of thoracic disease Pub Date : 2024-07-30 Epub Date: 2024-07-22 DOI:10.21037/jtd-24-794

Manman Liu, Chao Liang, Meijing Ying, Fulvia Ortolani, Biling Wu, Jie Liu, Zhen Yang, Wanxia Xiong, Ming Ding

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Abstract

Background: Cardiovascular surgeries often require deep hypothermic circulatory arrest and cardiopulmonary bypass (CPB), which can disrupt blood clotting and lead to excessive bleeding. Traditional treatments involve transfusing blood and blood products, which can have adverse effects and place significant strain on the global blood supply. Research suggests that autologous platelet-rich plasmapheresis (aPRP) may reduce the need for transfusions by preserving blood components. However, the impact of aPRP on postoperative blood loss and clinical outcomes in cardiovascular surgery remains controversial. This study aimed to examine the effects of aPRP on postoperative blood loss and recovery in patients undergoing heart valve surgery.

Methods: A total of 183 patients were divided into either aPRP or control groups. The aPRP group received aPRP before CPB, whereas the control group did not. The primary endpoint was postoperative bleeding between the groups. The secondary endpoints were postoperative bleeding risk factors and clinical outcome assessment. Logistic regression analysis with covariate adjustment was used to calculate these risk factors.

Results: A total of 76 patients (41.5%) in the aPRP group and 107 patients (58.5%) in the control group were included in the analysis. No significant difference was found in the occurrence of postoperative bleeding [odds ratio (OR) =0.53, 95% confidence interval (CI): 0.28-1.00, P=0.05], and the aPRP group had fewer complications than the controls (OR =0.28, 95% CI: 0.10-0.68, P=0.009). However, after adjusting for the New York Heart Association (NYHA) classification, diabetes, arrhythmology, mean activated clotting time (ACT_mean), CPB, bleeding, thoracotomy, and body mass index (BMI), there was a significant difference in postoperative bleeding (adjusted OR =0.47, 95% CI: 0.22-0.98, P=0.04) and complications (adjusted OR =0.23, 95% CI: 0.07-0.64, P=0.008) between the two groups.

Conclusions: Preoperative aPRP can improve postoperative outcomes and reduce complications in patients undergoing heart valve surgery.

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术前自体富血小板血浆置换术对心脏瓣膜手术患者术后出血的影响。

背景：心血管手术通常需要深低温循环停止和心肺旁路（CPB），这会破坏血液凝固并导致出血过多。传统的治疗方法包括输血和血制品，这可能会产生不良影响，并对全球血液供应造成巨大压力。研究表明，自体富血小板血浆置换术（aPRP）可以通过保存血液成分来减少输血需求。然而，aPRP 对心血管手术术后失血量和临床结果的影响仍存在争议。本研究旨在探讨 aPRP 对心脏瓣膜手术患者术后失血量和恢复的影响：共有 183 名患者被分为 aPRP 组和对照组。aPRP组在CPB前接受aPRP，而对照组不接受。主要终点是两组间的术后出血量。次要终点是术后出血风险因素和临床结果评估。采用协变量调整的逻辑回归分析来计算这些风险因素：共有 76 名 aPRP 组患者（41.5%）和 107 名对照组患者（58.5%）参与分析。术后出血发生率无明显差异[几率比（OR）=0.53，95% 置信区间（CI）：0.28-1.00，P=0.05]，aPRP 组的并发症少于对照组（OR =0.28，95% CI：0.10-0.68，P=0.009）。然而，在对纽约心脏病协会（NYHA）分级、糖尿病、心律失常、平均活化凝血时间（ACTmean）、CPB、出血、开胸术和体重指数（BMI）进行调整后，两组在术后出血（调整后 OR =0.47，95% CI：0.22-0.98，P=0.04）和并发症（调整后 OR =0.23，95% CI：0.07-0.64，P=0.008）方面存在显著差异：术前aPRP可改善心脏瓣膜手术患者的术后效果并减少并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of thoracic disease RESPIRATORY SYSTEM-

CiteScore

4.60

自引率

4.00%

发文量

254

期刊介绍： The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.