1. Impact of Autologous Platelet Rich Plasma Transfusion On Clinical Outcomes In Ascending Aortic Surgery With Deep Hypothermic Circulatory Arrest Cardiothoracic and Vascular Anesthesia Department of Anesthesiology The University of Texas Medical School at Houston SF. Zhou, MD, A. Estrera, MD, T. LI, MD, C. Ignacio, MD, S. Panthayi, MD, H. Safi, MD, A.Chuang, Ph.D. R. Sheinbaum, MD

2. Autologous Platelet Rich Plasma Harvesting Platelet Rich Plasma WB aPRP RBC Collected by harvesting 15-20 ml/kg whole blood prior to CPB Fractionating off the PRP component. The goal was a yield of 10-15 ml/kg of aPRP.

3.  aPRP was used to reestablish hemostasis and significantly reduce intra-operative transfusions  Investigate the effect of aPRP transfusion on the clinical outcome of patients undergoing aortic arch surgery with deep hypothermic circulatory arrest (DHCA) Purpose

4.  Retrospectively reviewed 454 cases of ascending aorta and arch repair with DHCA.  Ages 18-80,  From Feb. 2003 to Dec. 2008.  200 patients underwent aPRP harvest and 254 patients did not. Materials and Methods

5. Patient Demographics

6. Intra-OP transfusion Unit Non-aPRP Group aPRP Group Differencep-value N=254N=200 PRBC5.282.472.81<0.0001 FFP6.322.24.11<0.0001 Platelets10.522.997.53<0.0001 Cryoprecipitate6.650.705.95<0.0001 Cell Saver4.743.351.31<0.0001

7. Perioperative Blood Transfusion

8. Results  In the PRP group 39/200 (19.5%) received no transfusions 129/200(64.5%) received no platelet transfusion 70/200(35%) required 4 or less units of transfusion

9. Post-Operative Complications Complication Non-aPRP Group N=254(% ) aPRP Group N=200(%) Total N=454 p-Value Tracheotomy32 (12.6%)8 (4%)400.0013 Coagulopathy Re-Open in 24h 41(16.14%) 17 (6.69%) 18 (9.0%) 6 (3.0%) 59 23 0.0247 0.0749 Dialysis CNS CVA TIA Encephalopathy CV MI Arrhythmia(AF) Cardiac arrest 33 (12.9%) 21(8.27%) 6(2.36%) 32(12.6%) 5(1.97%) 92(36.22%) 15(5.91%) 12 (6%) 5(2.5%) 4(2%) 10(5%) 3(1.5%) 73(36.5%) 9(4.5%) 45 26 10 42 8 165 24 0.0133 0.0086 0.7941 0.0055 0.7064 0.9510 0.5064

10. Discharge Outcome Discharge Non-aPRP Group N=254(% ) aPRP Group N=200(%) Total N=454 p-Value Home Long Term Care Death 143 (56.97%) 88 (35.6%) 20 (7.97%) 151 (75.5%) 40 (20%) 9 (4.5%) 294 128 29 0.0002

11. Morbidity

12. Conclusions  Use of aPRP in ascending arch repair with DHCA surgery resulted in reduced morbidity and mortality.  Prospective randomized controlled studies are required.