Abstract:

Objective To investigate the impact of autologous platelet-rich plasma on postoperative bleeding and patient prognosis in individuals undergoing heart valve surgery. Methods This study is a retrospective cohort study that included patients who underwent heart valve surgery at Xiamen Hospital， Zhongshan Hospital， Fudan University from September 2018 to January 2023. The patients were divided into two groups based on whether they underwent autologous platelet-rich plasma （aPRP） collection before surgery： Group A （no PRP collection） and Group B （PRP collection group）. The main endpoint measure was the volume of pericardial mediastinal drainage on the day of surgery （D0）， the first postoperative day （D1）， and the second postoperative day （D2）. The secondary endpoint indicators included postoperative mechanical ventilation time， duration of mediastinal drainage tube retention， length of stay in the intensive care unit （ICU）， postoperative hospitalization time， incidence of adverse events during postoperative hospitalization， and postoperative coagulation function. Propensity score matching was used to balance preoperative baseline characteristics， including gender， age， Body Mass Index （BMI）， prothrombin time （PT）， International Normalized Ratio （INR）， platelet count （PLT）， activated clotting time （ACT）， ASA grade， NYHA grade， surgical name， surgical method， and preoperative comorbidities. Based on the matched data， the effect of PRP on postoperative bleeding and prognosis in patients following heart valve surgery was investigated. Results After propensity score matching， Group B patients showed a significant decrease in D2 drainage volume compared to Group A ［（132.42 ± 84.11） vs. （218.39 ± 160.39）， P = 0.01］. Additionally， Group B had significantly shorter postoperative mechanical ventilation time ［（1.88 ± 0.99） vs. （2.7 ± 2.47）， P = 0.015］， ICU stay time ［（3.07 ± 2.01） vs. （4.97 ± 6.26）， P = 0.006］， and pericardial mediastinal drainage retention time ［（5.72 ± 1.85） vs. （9.23 ± 5.05）， P = 0.01］. Moreover， the overall incidence of adverse events was reduced in Group B compared to Group A ［5（8.3%） vs. 14（23%）， P = 0.024］. At D0， D1， and D2， there was no statistically significant difference in hospital stay or postoperative coagulation function between the two groups of patients. Conclusions PRP has been proven to minimize pericardial mediastinal drainage on the second postoperative day， as well as the duration of mechanical ventilation， ICU stay， retention of pericardial mediastinal drainage， and overall incidence of postoperative adverse events.

Key words: autologous platelet rich plasma, heart valve surgery, propensity score matching