PRP USE IN CARDIOTHORACIC

SURGERY

R. S. KHALAFI, M.D., FACS, FCCP

DIRECTOR,CARDIOTHORACIC SURGERY

NORTH TEX. AFFL. MED GROUP

Total for Treatment of

One Mediastenitis Case

$235,846.32

PATIENT PROFILE WITH MEDIASTENITIS

• 48 YEAR OLD WHITE MALE

• HISTORY OF HTN, HYPERLIPIDEMIA

• SMOKING, INSULIN DEPENDENT DIABETES

• SEVERE 3 VESSEL CORONARY ARTERY DISEASE

• PREVIOUS HEART ATTACK

HOSPITAL COURSE

• UNDERWENT 3 VESSEL BYPASS

• PURULENT DRAINAGE FROM STERNAL WOUND 5 DAYS AFTER THE SURGERY

• UNDERWENT REOPERATION FOR STERNAL DBRIEDEMENT AND CLOSURE

HOSPITAL COURSE

• REQUIRED 6 WEEKS OF VANCOMYCIN TREATMENT FOR MRSA INFECTION

• 3 WEEKS OF HOSPITALIZATION AND 3 WEEKS OF HOME HEALTH CARE

• REQUIRED 5 WEEKS OF OPEN WOUND DRESSING CHANGES

MEDIASTINITIS

• INFECTION OF THE STERNUM

• INCIDENCE OF MEDIASTENITIS IS 1-6%

• MOST DEVESTATING POST OPERATIVE COMPLICATION

• REQUIRES MULTIPLE OPERATIONS

• SOMETIMES REQUIRES RESECTION OF THE STERNUM WITH MUSCLE FLAP

MEDIASTINITIS

MEDIASTINITIS

• 2% RISK OF INFECTION IS QUOTED TO PATIENTS

• IF NOT DIAGNOSED EARLY WILL LEAD TO DEATH 100% OF THE TIME

WHY DO I DO IT

• OUT OF 450 CASES LAST YEAR WE HAD 5 MEDIASTINITIS AND NUMEROUS LEG INFECTIONS

• ONE DEATH FROM SEVERE SEPTECEMIA

• TREMENDOUS AMOUNT OF COST • MANY CASES OF CLEAR DRAINAGE

FROM THE WOUNDS

Technique

•110ml of blood is drawn

•Two GPS disposables are processed- One for the sternum- One for the graft harvest site on

the leg

After chest wires are put in but before tightening,half of the platelet rich plasma (PRP) is sprayed along the exposed sternal edges.

The wires are then tightened and the remaining PRP is sprayed over the subcutaneous tissue.

Platelet Poor Plasma (PPP) is then applied to each layer upon closure. Leave PPP is place and sew through PPP gel. Do not lap up after applying.

Platelet Rich Plasma (PRP) is delivered through a long, dual cannula and backfilled along the graft harvest site.

PRP Application

After applying Platelet Rich Plasma (PRP) to the leg, apply the Platelet Poor Plasma (PPP) in the same fashion with a long, dual cannula tip.

PPP Application

RESULTS

• 700 CASES TO DATE

• ONE CASE OF MEDIASTINITIS AND ONE LEG INFECTION

• RAPID WOUND HEALING

• EXTREMELY SMALL NUMBER WITH WOUND DRAINAGE

THANK YOU