Fresh Frozen Plasma Compared to Crystalloid as Priming Solution for Cardiopulmonary Bypass in Left Ventricular Assist Device Implantation

The Thoracic and Cardiovascular Surgeon, vol. 74, pp. S1–S70

Abstract

All articles of this category (opens in new window) Background: Fresh frozen plasma (FFP) is frequently used in pediatric cardiac surgery as a priming solution for cardiopulmonary bypass (CPB) to mitigate bleeding and reduce perioperative complications; however, robust evidence to support this practice is limited, and data in adult cardiac surgery are even scarcer. The aim of this study was to evaluate the effect of CPB priming with FFP on perioperative outcomes, particularly postoperative bleeding, transfusion requirements, hemodynamic stability, and mortality in patients undergoing left ventricular assist device (LVAD) implantation. Methods: We conducted a retrospective analysis of 80 patients who underwent LVAD implantation at our institution between January 2021 and April 2025. Patients were stratified according to the CPB priming strategy, comparing plasma-based ( n = 35) with crystalloid-based ( n = 45) priming solutions. Co-primary outcomes were chest tube drainage volume as a measure of postoperative bleeding, requirement for blood product transfusions, requirement for vasoactive and inotropic medications, quantified by the Maximum Vasoactive-Inotropic Score (VISmax) and Cumulative Vasoactive-Inotropic Score (VIS-index). Secondary outcomes included postoperative hepatic and renal function, inflammatory response, and mortality. Results: Patients with plasma-based priming compared to crystalloid-based priming had a lower incidence of postoperative dialysis (7 (20%) vs. 20 (44.4%), p = 0.035), a lower incidence of right heart failure (3 (8.6%) vs. 14 (31.1%), p = 0.030), higher postoperative hemoglobin values (10.3 ± 1.2 vs. 9.4 ± 1.4 g/dL, p = 0.008), and higher postoperative plasma-protein values (5.2 ± 0.4 g/dL vs. 4.8 ± 0.4 g/dL, p = 0.013). The overall survival did not differ between the two groups (log-rank, p = 0.140). No difference in postoperative bleeding incidence or VIS-index was noted. Conclusion: In this single-center retrospective cohort, FFP-based CPB priming was associated with less severe postoperative organ dysfunction—namely, lower dialysis use and RHF—without reductions in bleeding, transfusion needs, vasoactive support, or mortality. These hypothesis-generating findings suggest potential hemodynamic/oncotic benefits of FFP priming but do not support its routine use for bleeding prophylaxis. Larger prospective studies, ideally randomized, are needed to confirm efficacy, define patient selection, and weigh benefits against added transfusion exposure and cost. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Authors 6

1. S. Bonni Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

2. Rashad Zayat Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

3. MC. Sales Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

4. NWM. Ramnath Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

5. Lachmandath Tewarie Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

6. A. Moza Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland