This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leif Pierre Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Koul, B. Articles by Pierre, L. Search for Related Content PubMed Articles by Koul, B. Articles by Pierre, L. Related Collections Related Article

ICVTS on-line discussion A1 Reply to Kan

Cardiothoracic Surgery, University Hospital Lund, 22185 Lund, Sweden

Acute plateletpheresis and aprotinin reduces the need for bloodtransfusion following Ross operation

eResponse: Our study [1] has shown that acute intraoperative plateletpheresis (APP), harvesting platelet-rich plasma equivalent to 25% of the estimated circulating platelet count; in combination with low-dose aprotinin reduces significantly the need for perioperative transfusion of blood products in comparison to low-dose aprotinin alone in patients undergoing Ross operation. Following complex cardiac surgery under cardio-pulmonary bypass (CPB), for APP alone to be effective, what we need to investigate in a prospective manner is the magnitude of an effective APP. This question becomes more pertinent if one plans to utilise APP in patients undergoing surgery under deep hypothermia and circulatory arrest, in which aprotinin is relatively contraindicated. Till the time this question is answered, it appears that the combination of APP with aprotinin or an antifibrinolytic drug reduces the need for perioperative transfusion significantly in comparison to APP alone in patients undergoing complex cardiac surgery under CPB [2]. At present our policy is to give all patients undergoing major cardiac surgery, except those subjected to deep hypothermia and circulatory arrest, 2 million units of aprotinin directly into the CPB circuit after the patients have been re-warmed to 350 °C. This policy enables us to use deep hypothermic circulatory arrest, without hesitation, if we decide for that during on-going routine CPB.

	References

Top References

 

1. Al-Rashidi F, Bhat M, Pierre L, Koul B. Acute plateletpheresis and aprotinin reduces the need for blood transfusion following Ross operation. Interact CardioVasc Thorac Surg 2007; 6:618–622.[Abstract/Free Full Text]
2. Stover EP, Siegel LC, Hood PA, O' Riordan GE, McKenna TR. Platelet-rich plasma sequestration, with therapeutic platelet yields, reduces allogeneic transfusion in complex cardiac surgery. Anesth Analg 2000; 90:509–516.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leif Pierre Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Koul, B. Articles by Pierre, L. Search for Related Content PubMed Articles by Koul, B. Articles by Pierre, L. Related Collections Related Article