Application of autologous platelet rich plasma in Sun's procedure for acute type A aortic dissection under moderate hypothermia.

Coagulopathy and inflammatory response are the intractable complication during Sun's procedure for type A aortic dissection (AAD). This study aims to investigate the efficacy of autologous platelet rich plasma (aPRP) on the patients undergoing Sun's procedure under moderate hypothermia. A total of 372 AAD patients who underwent Sun's procedure under moderate hypothermia were divided into aPRP group (aPRP was separated before heparinization and transfused after protamine neutralization) and Non-aPRP group (without aPRP apheresis). Preoperative characteristics, intraoperative data, postoperative outcomes, and perioperative laboratory reports were collected and analyzed. The operation time (301.1 ± 21.3 vs. 318.1 ± 29.9, P < 0.001), postoperative ventilation time [25.3[19.2, 37.0] vs. 31.9[25.4, 43.1], P < 0.001] and cardiac intensive care unit stay [4.8[3.5, 7.9] vs. 8.7[4.9,11.2], P < 0.001] in aPRP group were significantly shorter than that in Non-aPRP group. Intraoperative blood loss (637.2 ± 24.9 vs. 908.4 ± 51.0, P < 0.001), transfusion of allogeneic blood products (PLT: 2.11 ± 1.03 vs. 2.52 ± 0.83, P < 0.001; Plasma: 405.6 ± 55.6 vs. 421.0 ± 61.7, P = 0.012; Cryoprecipitate: 9.7 ± 2.4 vs. 10.4 ± 1.9, P = 0.002; RBC: 422.7 ± 64.9 vs. 479.2 ± 81.0, P < 0.001) and the incidence of postoperative pulmonary complications (8.2% vs. 16.2%, P = 0.027) were reduced in aPRP group. The costs of both blood products (9,202.2 ± 1,597.4 vs. 10,031.9 ± 3,471.8, P = 0.003) and the total hospitalization (243.5 ± 33.1 vs. 297.6 ± 43.5, P < 0.001) were decreased in aPRP group. Furthermore, intraoperative and postoperative levels of C-reactive protein and Interleukin-6 (P < 0.001) in aPRP group were lower than that in Non-aPRP group. There was no significant difference in renal, cerebral complications and hospital stay between the two groups. Application of aPRP in Sun's procedure reduced the perioperative blood loss and allogeneic blood transfusion, contributed to the decreased postoperative pulmonary complications and shortened intensive care unit duration. Apheresis and re-infusion of aPRP in Sun's procedure alleviated postoperative inflammation to a certain degree and was a desirable approach for AAD patients.