European Journal of Cardio-Thoracic Surgery, Vol 10, 1083-1089, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Autologous platelet sequestration in patients undergoing coronary artery bypass grafting
JT Christenson, J Reuse, P Badel, B Nowicki, F Simonet and M Schmuziger
The Cardiovascular Unit, Hopital de la Tour, Meyrin-Geneva, Switzerland.
OBJECTIVES: Blood conservation remains an important issue for patients
undergoing cardiac surgery with cardiopulmonary bypass. Platelet
sequestration (PSQ) is an aggressive autologous blood conservation method,
whose effectiveness is still debated. The main objective of the present
study was to evaluate whether PSQ reduces postoperative blood transfusion
requirements in patients undergoing coronary artery bypass grafting (CABG)
and to determine if PSQ is a cost-effective blood conservation method.
MATERIAL AND METHODS: All adult patients admitted for CABG entered the
study. Exclusion criteria were: recent blood transfusion (<7 days), a
platelet count of 150x10(3)/microl or less, hematocrit less than 35% and
body weight 50 kg or less. The sequestration was aim 20% or more of the
total platelet plasma volume. The sequestration protocol was three
sequestration cycles performed just prior to surgery. The concentrated
platelet portion was reinfused after weaning from the cardiopulmonary
bypass. Hundred seven parameters/patients were recorded. Sixty patients
entered the study; 30 in the PSQ group and 30 controls (CTR). RESULTS:
Patient characteristics, operation data, preoperative hematology and
coagulation parameters did not differ between the groups. In the PSQ group
a mean of 433+/-34 ml concentrated platelet portion was collected. The mean
platelet count in the concentrated platelet portion was
749+/-157x10(3)/microl, resulting in a platelet yield of 28+/-6% (2040%).
The average total chest tube blood loss was 423 ml (PSQ) compared to 858 ml
(CTR), p<0.001. A greater number of CTR patients required blood
transfusion postoperatively (23) compared to PSQ (3), P<0.001, and fluid
requirements were also significantly increased in the control group,
P<0.001. No statistical differences in hematology and coagulation
parameters between the groups were observed. The hospital mortality was low
and the incidence of postoperative complications was few and without group
differences. Post-extubation gas exchange was better in PSQ patients
compared to CTR. CONCLUSIONS: A preoperative PSQ of a minimum 20% of the
total platelet plasma volume resulted in significantly lower postoperative
blood loss and fluid and blood transfusion requirements compared to
controls. Post-extubation gas exchange was also better after PSQ. Only one
patient did not tolerate the sequestration. No other adverse effects of the
procedure were observed.
