The use of preoperative Autologous platelet-pheresis to reduce the amount of homologous blood transfusion in patients undergoing repeated valvular surgery.

Autologous platelet-pheresis was performed prior to the initiation of cardiopulmonary bypass in 11 patients who underwent elective repeated valvular surgery. The average time to complete platelet-pheresis was 74′30 min. (range, 36 to 144 min.). A volume of 287′119 ml of platelet concentrate (PC) was obtained from 4,365′1,576 ml of blood, and the entire amount was then reinfused after the termination of cardiopulmonary bypass. The mean yield of the platelets was 2.0′ 0.7×10 1 1 , which thus represented 36′17% of the circulating platelets. One instance of hospital death was encountered due to postoperative hepatic failure. Of the 21 hospital survivors who underwent elective repeated valvular surgery between January 1999 and June 2001, autologous PC was harvested from 10 patients (the PC group), but was not performed in the other 11 patients (non-PC group). Although the amount of perioperative blood loss in the PC group was less than that in the non-PC group, the difference did not reach statistical significance. Regarding homologous blood utilization during hospitalization, the requirement of packed red cells in the PC group was significantly less than that in the non-PC group (8.6′10.5 5 units vs. 17.2′8.0 units, p<0.05). All patients in the non-PC group required homologous PC transfusions, while 50% of the patients in the PC group did not (p< 0.01). Moreover, only 30% of the patients in the PC group avoided exposure to any homologous blood products (p<0.01). In conclusion, the use of preoperative autologous platelet-pheresis was found to reduce the amount of homologous blood transfusion required by patients undergoing repeated valvular surgery.