الفهرس 
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Abstract
The value of thymectomy in management of myasthenia gravis (MG) is well recognized. As PLEX has its own complications, selective use of PLEX preoperatively for patients at risk of post- thymectomy complications would improve the postoperative outcome, and decreases the PLEX-related complications. Role of plasma exchange before thymectomy remains controversial. The aim of this study is to evaluate the effectiveness and safety of routine versus selective use of PLEX before thymectomy.
A prospective study of two different protocols in two cardiothoracic institutions comparing the routine (group I) versus selective use (group II) of prethymectomy PLEX. 60 patients diagnosed with MG who underwent thymectomy between September 2016 and Septemper 2019, were divided into 2 groups.
In group I, all patients (n=30) were treated with PLEX before thymectomy. In group II (30 patients), 17 patients were identified as high-risk and were treated with PLEX before thymectomy, and in 13 patients, thymectomy was performed without preoperative PLEX. There was significant difference in the recorded PLEX-related complications between group I and group II; 27% (8 patients) versus 10% (3 patients), respectively. There was no difference between the two groups as regard the duration of postoperative mechanical ventilation, intensive care unit (ICU) stay and hospital stay.
This study demonstrated that selective use of PLEX before thymectomy may reduce the incidence of PLEX-related complications without affecting the overall outcome.