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PRP USE IN CARDIOTHORACIC
SURGERY
R. S. KHALAFI, M.D., FACS, FCCP
DIRECTOR,CARDIOTHORACIC SURGERY
NORTH TEX. AFFL. MED GROUP
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Total for Treatment of
One Mediastenitis Case
$235,846.32
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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
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HOSPITAL COURSE
• UNDERWENT 3 VESSEL BYPASS
• PURULENT DRAINAGE FROM STERNAL WOUND 5 DAYS AFTER THE SURGERY
• UNDERWENT REOPERATION FOR STERNAL DBRIEDEMENT AND CLOSURE
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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
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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
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MEDIASTINITIS
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MEDIASTINITIS
• 2% RISK OF INFECTION IS QUOTED TO PATIENTS
• IF NOT DIAGNOSED EARLY WILL LEAD TO DEATH 100% OF THE TIME
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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
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Technique
•110ml of blood is drawn
•Two GPS disposables are processed- One for the sternum- One for the graft harvest site on
the leg
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After chest wires are put in but before tightening,half of the platelet rich plasma (PRP) is sprayed along the exposed sternal edges.
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The wires are then tightened and the remaining PRP is sprayed over the subcutaneous tissue.
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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.
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Platelet Rich Plasma (PRP) is delivered through a long, dual cannula and backfilled along the graft harvest site.
PRP Application
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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
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RESULTS
• 700 CASES TO DATE
• ONE CASE OF MEDIASTINITIS AND ONE LEG INFECTION
• RAPID WOUND HEALING
• EXTREMELY SMALL NUMBER WITH WOUND DRAINAGE
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THANK YOU