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Ann Thorac Surg 1990;50:62-68
© 1990 The Society of Thoracic Surgeons

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Articles

Acute preoperative plasmapheresis and established blood conservation techniques

Department of Anesthesiology and Intensive Care Medicine and Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Federal Republic of Germany

Accepted for publication January 18, 1990.

^_* Address reprint requests to Dr Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikstr 29, Justus-Liebig-University Giessen, D-6300 Giessen, FRG.

Plasmapheresis performed weeks before an operation producing autologous plasma has proved to be of benefit in elective operations. First experiences in acute plasmapheresis, which is performed immediately before the operation, have been reported recently. When acute plasmapheresis is used in cardiac operations, however, it must be viewed in connection with other techniques for reducing blood consumption such as the Cell Saver (CS) and ultrafiltration devices. In 60 patients undergoing elective aortocoronary bypass grafting, acute plasmapheresis was performed, producing either platelet-poor plasma or platelet-rich plasma, in combination with either the Cell Saver or hemofiltration. Fluid balance during cardiopulmonary bypass was significantly lower in the hemofiltration patients. Postoperatively, none of these patients received donor blood, whereas 4 patients of the Cell-Saver groups needed packed red blood cells. AT-III, fibrinogen, the number of platelets, albumin, total protein, and colloid osmotic pressure were less compromised when hemofiltration was used in combination with acute plasmapheresis in contrast to combination with the Cell-Saver technique. Plasma hemoglobin was without differences during the investigation period, and polymorphonuclear elastase was less increased when platelet-rich plasma was produced preoperatively. On the first postoperative day, most of the differences between the groups had already disappeared. We conclude that when acute plasmapheresis is used in cardiac operations, discarding of plasma by the Cell Saver should be avoided and ultrafiltration devices should replace centrifugation techniques for blood conservation.

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