Does Autologous Platelet-Rich Plasma Improve Blood Conservation and Postoperative Outcomes in Acute Type A Aortic...

To evaluate whether autologous platelet-rich plasma (aPRP) improves blood conservation and postoperative outcomes in emergency surgery for acute type A aortic dissection (ATAAD).

Systematic review and meta-analysis of randomized controlled trials and observational studies.

Cardiac surgery centers from multiple institutions.

Six studies comprising 2,150 adult patients undergoing ATAAD repair, of whom 906 (42.1%) received intraoperative aPRP.

Use of intraoperative aPRP versus no aPRP during ATAAD repair.

Primary outcomes included reoperation for bleeding and allogeneic blood product transfusion volumes. Secondary outcomes were mechanical ventilation duration, hospital stay, and postoperative complications. aPRP was associated with significantly shorter mechanical ventilation time (MD -13.8 hours; 95% CI -23.9 to -3.7; p = 0.008), lower incidence of prolonged ventilation (OR 0.3; 95% CI 0.2 to 0.7; p = 0.004), reduced reoperation rates (OR 0.4; 95% CI 0.2 to 0.7; p = 0.005), and decreased platelet (MD -2.2 units; 95% CI -3.5 to -0.9; p = 0.001) and cryoprecipitate use (MD -1.9 units; 95% CI -3.0 to -0.8; p < 0.001). No differences were observed in mortality, hospital stay, or rates of neurological or renal complications. Subgroup analysis of randomized controlled trial and propensity-matched data confirmed several of these findings and additionally showed reduced plasma transfusion volumes.

In ATAAD surgery, aPRP may reduce transfusion needs, reoperations, and ventilation duration without increasing adverse outcomes. Given that most evidence is observational, high-quality randomized trials are needed to confirm these findings.