Plasmapheresis, a Useful Tool for Better Outcome of Patients Undergoing Thymectomy for Myasthenia Gravis

Abstract

Background: Thymectomy for widespread Myasthenia gravis may be associated with a turbulent postoperative course especially if preoperative circulating acetylcholine receptor autoantibody levels are towering. Plasmapheresis remove these antibodies. The aim of this study was to explore the results of preoperative Plamapheresis on postoperative course after thymectomy. Material And Method This is a retrospective study at tertiary care center where 13 patients of myasthenia gravis were operated in 3 year duration (2017-2020). All patients had undergone 2 cycles of plasmapheresis before surgery. Result was evaluated postoperatively in ICU, at the time of discharge, and at follow up after 7 days, 1 month and 6 month in terms of weaning from ventilator, ICU stay, level of autoantibodies and length of hospital stay, improvement in symptoms, and mortality. Results Out of 13 patients 5 (38.46%) were male and 8 (61.54%) were female in the age range of 20 to 60 years. 6 (46.15%) were in stage IIA and 7 (53.85%) in stage IIB. Preoperative autoantibody levels were in the range of 30-50 nmol/ml. Almost total thymectomy was done in all patients. Patients were extubated with in 4-6 hrs after surgery and there was no mortality. Patients were discharged at postoperative day 4-7. Conclusion The study shows that preoperative use of plasmapheresis to reduce the autoantibody level is associated with an early extubation, early discharge and less complication after thymectomy.