Intraoperative plasmapheresis in cardiac surgery

Objective: To determine the effects of intraoperative plasmapheresis on total transfusion requirements, mediastinal drainage, and coagulation. Design: The trial was prospective, randomized, and controlled. Setting: Inpatient cardiac surgery at a university medical center. Participants: Two hundred ninety-three consecutive patients undergoing cardiac surgery requiring cardiopulmonary bypass. Interventions: Intraoperative plasmapheresis (IP) was performed in 147 patients before heparinization; platelet-rich plasma was reinfused immediately after heparin reversal. Measurements and Main Results: Mediastinal chest tube drainage during the first 12 postoperative hours was significantly less in the IP group (p = 0.022), but no difference was noted in total postoperative blood loss between the two groups. The amount of packed red cells and fresh frozen plasma transfused to the IP group in the intensive care unit was significantly lower (p = 0.02, p = 0.002, respectively); 51.4% of patients required no transfusion compared with the control group (34.5%) (p = 0.006). No differences were noted for data collected in the intensive care unit in terms of the mean duration of chest tube drainage, ventilator time, or any hematologic variables at baseline or at any subsequent time in the study. Conclusions: After cardiac surgery, intraoperative plasma-pheresis reduces early postoperative bleeding and decreases the need for homologous transfusions. Copyright (C) 1997 by W.B. Saunders Company.