Ann Thorac Surg 1996;62:1378-1379
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Gerald G. Davies, MD
Anesthesia and Pain Consultants, PC Mississippi Medical Plaza, 3400 Dexter Court, Davenport, IA 52807
See also page 1373.
This is an important randomized, prospective study because particular attention was given to assuring an adequate yield of platelets in the harvested product, and the differences between the study and control groups are of major clinical importance. Our findings using autologous plateletpheresis, with adequate quality control of the product, in more than 2,000 cases confirms Christenson and associates' work, particularly in high-risk and redo operations.
Since its introduction more than 8 years ago, intraoperative platelet salvage, although intuitively appealing, has failed to become a widely accepted procedure for several reasons:
- There are several technical difficulties that have not been addressed satisfactorily by the equipment manufacturers. The technique used in this study is still much more cumbersome and time-consuming than it needs to be; for instance, two blood drawing sites were used, processed blood was bagged, the ratio of citrate anticoagulant to blood was manually regulated, and only three cycles were performed in 72 minutes to obtain 6 units of platelets. On the other hand, using different equipment and protocol we averaged 10 cycles in 55 minutes and obtained yields of 14 units.
- Platelet salvaging of 59% ± 22% of platelet mass is now performed routinely for our open heart patients. It is, however, little used in other institutions in part because of the lack of a prospective, nonflawed study and the absence of major investment, training, support, and service from equipment manufacturers.
- The procedure, although not inherently complicated or dangerous, requires a major commitment and coordination of many providers in the healthcare team including the surgeon, anesthesiologist, perfusionist, and a trained individual to be available to perform the procedure.
- Facility with the procedure follows a learning curve, and it is not surprising that in some centers it has been abandoned in the face of early frustrations.
This study should give impetus to the further development and improvement of techniques to accomplish effective intraoperative plateletpheresis.
Related Article
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Plateletpheresis Before Redo CABG Diminishes Excessive Blood Transfusion
- Jan T. Christenson, Jeanine Reuse, Pierre Badel, François Simonet, and Martin Schmuziger
Ann. Thorac. Surg. 1996 62: 1373-1378.
[Abstract]
[Full Text]
