Key result
Autologous platelet-rich plasma application during aortic arch replacement significantly reduced the incidence of postoperative pleural effusion (76.66% vs. 83.99%, OR 1.59) and cryoprecipitate transfusion.
Why the study?
Coagulopathy and massive bleeding are common complications requiring many transfusions during acute type A aortic dissection repair, and the effects of autologous platelet-rich plasma on blood conservation and postoperative outcomes needed investigation.
Does autologous platelet-rich plasma application improve postoperative conditions and reduce blood product transfusion in patients with acute type A aortic dissection undergoing aortic arch replacement?
Cohort (n=610)
No
Does autologous platelet-rich plasma application improve postoperative conditions and reduce blood product transfusion in patients with acute type A aortic dissection undergoing aortic arch replacement?
Odds Ratio: 1.59 (95% CI 1.04–2.45)
Absolute Event Rate: 76.66% vs 83.99%
p-value: p=0.028
Autologous platelet-rich plasma application during aortic arch replacement for acute type A aortic dissection may reduce cryoprecipitate transfusion needs and decrease the incidence of postoperative pleural effusion.
PRP may aid transfusion reduction in aortic arch repair; leaves open efficacy and safety pending randomized trials.
Background Coagulopathy and massive bleeding are common complications of patients with Stanford type A acute aortic dissection repair, and patients with these complications require many transfusions. Autologous platelet-rich plasma (PRP) is widely used to reduce the need for blood products. In the present study, we aimed to investigate the effects of PRP on blood conservation and the postoperative conditions of patients who underwent aortic arch replacement. Methods Patients with aortic dissection undergoing aortic arch replacement were included initially application In all, 837 patients were divided into the PRP and non-PRP groups according to PRP use, whereupon a propensity score match was performed. The data analyzed included patient basic information, intraoperative information, postoperative biochemical examinations, and CTA reports. Results In total, 610 patients were finally included (305 patients per group). Groups were well balanced after matching. Compared to the non-PRP group, less cryoprecipitate was transfused in the PRP group (10.0 [7.5, 11.0] vs. 10.0 [10.0, 11.5], P = 0.021), while no differences were found in packed RBC, FFP, and platelets between the two groups. Also, the surgery variables showed no differences. After surgery, patients in the PRP group showed higher postoperative serum albumin (36.43 ± 4.20 vs. 35.39 ± 4.40 g/L, P = 0.004) and total protein levels (59.38 ± 6.25 vs. 58.06 ± 7.19 g/L, P = 0.019) than the non-PRP group, but no significant differences in the levels of ALT, AST, Scr, and BUN. CTA reports showed that the proportion of patients with pleural effusion was lower in the PRP group (76.66% vs. 83.99%, OR = 1.59, 95% CI: 1.04–2.45, P = 0.028), while the proportions of pericardial effusion were not significantly different. Conclusions PRP application in aortic arch replacement surgery reduced the transfusion of cryoprecipitate, increased the postoperative serum albumin and total protein levels, and reduced the incidence of pleural effusion. No effect of PRP application was found on other postoperative blood indicators and CTA reports.
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Wei et al. (2022) conducted a cohort in Stanford type A acute aortic dissection (n=610). Autologous platelet-rich plasma vs. No autologous platelet-rich plasma was evaluated on Pleural effusion (OR 1.59, 95% CI 1.04-2.45, p=0.028). Autologous platelet-rich plasma application during aortic arch replacement significantly reduced the incidence of postoperative pleural effusion (76.66% vs. 83.99%, OR 1.59) and cryoprecipitate transfusion.
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