Evaluation of autologous platelet rich plasma for cardiac surgery: outcome analysis of 2000 patients

Amit N Patel, Craig H Selzman, Ganesh S Kumpati, Stephen H McKellar, David A Bull, Amit N Patel, Craig H Selzman, Ganesh S Kumpati, Stephen H McKellar, David A Bull

Abstract

Background: Deep and superficial sternal wound infections (DSWI & SWI) following cardiac surgery increase morbidity, mortality and cost. Autologous platelet rich plasma (PRP) derived from the patient's own blood has been used in other surgical settings to promote successful wound healing. The goal of this study was to analyze the addition of PRP using a rapid point of care bedside system to standard wound care in all patients undergoing sternotomy for cardiac surgical procedures.

Methods: Over a 7 year period, 2000 patients undergoing open cardiac operations requiring sternotomy were enrolled. One thousand patients received standard of care sternal closure. The other 1000 patients received standard of care sternal closure plus PRP applied to the sternum at the time of closure. The outcomes related to wound healing, infection, readmissions, and costs were analyzed.

Results: In the 2000 patients, there were more ventricular assist device implants/heart transplants and emergency operations in the PRP group; otherwise there were no significant differences. The use of PRP reduced the incidence of DSWI from 2.0 to 0.6 %, SWI from 8.0 to 2.0 %, and the readmission rate from 4.0 to 0.8 %. The use of PRP reduced the costs associated with the development of deep and superficial wound complications from $1,256,960 to $593,791.

Conclusions: The use of PRP decreases the incidence and costs of sternal wound complications following cardiac surgery. The routine use of platelet rich plasma should be considered for all patients undergoing sternotomy for cardiac surgical procedures.

Trial registration: Clinicaltrials.gov ( NCT00130377 ) for the data registry.

Keywords: Cardiac surgery; Infections; Platelets; Sternal; Wounds.

Figures

Fig. 1
Fig. 1
Time to infection post-surgery. The time to infection post-surgery was reported as number of patients with infections. PRP DSWI- platelet rich plasma deep sternal wound infection, Control DSWI – control with deep sternal wound infection, PRP SSWI- platelet rich plasma superficial sternal wound infection, Control SSWI – control with superficial sternal wound infection

References

    1. Schimmer C, Sommer SP, Bensch M, Leyh R. Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers. Interact Cardiovasc Thorac Surg. 2007;6:708–11. doi: 10.1510/icvts.2007.164004.
    1. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothoracic Surg. 2001;6:1168–75. doi: 10.1016/S1010-7940(01)00991-5.
    1. Robinson PJ, Billah B, Leder K, Reid CM. ASCTS database committee factors associated with deep sternal wound infection and haemorrhage following cardiac surgery in Victoria. Interact Cardiovasc Thorac Surg. 2007;6:167–71. doi: 10.1510/icvts.2006.132191.
    1. Tundermann S, Dademasch A, Praetorius J, Kempfert J, Dewey T, Falk V, Mohr FW, Walther T. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011;1:33–7. doi: 10.1016/j.ejcts.2010.04.013.
    1. Fleck TM, Fleck M, Moidl R, Czerny M, Koller R, Giovanoli P, Hiesmayer MJ, Zimpfer D, Wolner E, Grabenwoger M. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery. Ann Thorac Surg. 2002;74:1596–600. doi: 10.1016/S0003-4975(02)03948-6.
    1. Douville EC, Asapj JW, Dworkin RJ, Handy JR, Canepa CS, Grunkemeier GL, Wu Y. Sternal preservation: a better way to treat most sternal woun complications after cardiac surgery. Ann Thorac Surg. 2004;78:1659–64. doi: 10.1016/j.athoracsur.2004.04.082.
    1. Immer FF, Durrer M, Muhlemann KS, Erni D, Gahl B, Carrel TP. Deep sternal wound infection after cardiac surgery: modality of treatment and outcome. Ann Thorac Surg. 2005;80:957–61. doi: 10.1016/j.athoracsur.2005.03.035.
    1. Jameson CA. Autologous platelet concentrate for the production of platelet gel. LabMed. 2007;38:39–42.
    1. Trowbridge CC, Stammers AH, Woods E, Yen BR, Klayman M, Gilbert C. Use of platelet gel and its effects in infection in cardiac surgery. J Extra Corpor Technol. 2005;37:381–6.
    1. Englert SJ, Estep TH, Ellis-Stoll CC. Autologous platelet gel applications during cardiovascular surgery: effect on wound healing. J Extra Corpor Technol. 2005;37:148–52.
    1. Vang SN, Brady CP, Christensen KA, Allen KR, Anderson JE, Isler JR, Holt DW, Smith LM. Autologous platelet gel in coronary artery bypass grafting: effects on surgical wound healing. J Extra Corpor technol. 2007;39:31–8.
    1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guide-line for prevention of surgical site infection hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250–78. doi: 10.1086/501620.
    1. Massetti M, Babatasi G, Bhoyroo S, Khayat A. The “sternum calvary”. [letter] J Thorac Cardiovasc Surg. 1999;117:410–1. doi: 10.1016/S0022-5223(99)70458-7.
    1. Kirbas A, Celik S, Gurer O, Yildiz Y, Isik O. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy. Tex Heart Inst J. 2011;38(2):132–6.
    1. Celik S, Kirbas A, Gurer O, Yildiz Y, Isik O. Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: the value of supportive thorax vests. J Thorac Cardiovasc Surg. 2011;141(6):1398–402. doi: 10.1016/j.jtcvs.2011.01.042.
    1. Kamiya H, Al-maisary SS, Akhyari P, Ruhparwar A, Kallenbach K, Lichtenberg A, Karck M. The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients. Interact Cardiovasc Thorac Surg. 2012;15(4):665–70. doi: 10.1093/icvts/ivs293.
    1. Fischer JP, Basta MN, Wink JD, Nelson JA, Serletti JM, Kovach SJ, Low DW, Vallabhajosyula P, Acker MA, Kanchwala S. An internally validated risk model of deep sternal wound infection (DSWI): a review of 5,179 patients undergoing index median sternotomy procedures. Plast Reconstr Surg. 2014;133(4 Suppl):1011–2. doi: 10.1097/01.prs.0000445831.99223.bc.
    1. Dominijanni A, Cristofaro MG, Brescia A, Giudice M. Platelet gel in oral and maxillofacial surgery: a single-centre experience. Blood Transfus. 2012;2:200–4.
    1. Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Krol W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances-an in vitro study. J Bone Joint Surg (Br) 2007;7:417–20. doi: 10.1302/0301-620X.89B3.18491.
    1. Buchwald D, Kaltschmidt C, Haardt H, Laczkovics A, Reber D. Autologous platelet gel fails to show beneficial effects on wound healing after saphenectomy in CABG patients. J Extra Corpor technol. 2008;3:196–202.
    1. Dorge H, Sellin C, Bury MC, Drescher A, Seipelt R, Grossmann M, Danner BC, Schoendube FA. Incidence of deep sternal would infection is not reduced with autologous platelet rich plasma in high-risk cardiac surgery patients. Thorac Cardiovasc Surg. 2013;3:180–4.
    1. Limathe J, Philipp C, Kurt M, Boeken U, Gams E, Feindt P. The use of autologous platelet gel (APG) for high-risk patients in cardiac surgery-is it beneficial? Perfusion. 2009;6:381–7. doi: 10.1177/0267659109358283.
    1. Khalafi RS, Bradford DW, Wilson MG. Topical application of autologous blood products during surgical closure following a coronary artyery bypass graft. Eur J Cardiothorac Surg. 2008;2:360–4. doi: 10.1016/j.ejcts.2008.04.026.
    1. Everts PA, Mahoney CB, Hoffmann JJ, Schonberger JP, Box HA, Zundert AZ, Knape JT. Platelet-rich plasma preparation using three devices: implications for platelet activation and platelet growth factor release. Growth Factors. 2006;3:165–71. doi: 10.1080/08977190600821327.
    1. Hamman BL, Stout LY, Theologes TT, Sass DM, da Graca B, Filardo G. Relation between topical application of platelet-rich plasma and vancomycin and severe deep sternal wound infections after a first median sternotomy. Am J Cardiol. 2014;113(8):1415–9. doi: 10.1016/j.amjcard.2013.12.046.
    1. Mustafa A, Carr C, Alkhafagi S, Mughal N, Omer M, Alkhulaifi A. Late presentation of a deep sternal wound infection and left breast abscess. J Wound Care. 2014;23(2 Suppl):S23–5. doi: 10.12968/jowc.2014.23.Sup2b.S23.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する